Therapeutic strategy of central vein perforation accompanied by a mediastinal lesion after catheterization

Abstract

Central vein perforation associated with a mediastinal lesion is a rare complication of catheterization. A 50-year-old woman was diagnosed with chronic kidney disease and required hemodialysis treatment. The patient developed central vein injury during attempted placement of a double-channel catheter. A computed tomographic scan and venography showed that the catheter had punctured the mediastinum from the central vein. After comprehensive assessment and multidisciplinary consultation, percutaneous catheter thrombin injection with follow-up balloon dilatation under fluoroscopy guidance successfully fixed the perforation. We summarize the therapeutic strategy of this complication and other treatment options, and discuss the related literature of central vein injury.

Hemodialysis catheter malpositioned into the mediastinum: Lessons from two cases

“…The outcomes of these published cases ranged from favorable to fatal. [3][4][5][6][7][8][9] Clinical outcomes or treatment plans for patients with HDC malpositioned into the mediastinum should be considered according to the position of the injured vessels. Injury of relatively large veins, such as the innominate vein or the superior vena cava, can lead to fatal outcomes, which can require emergency interventions such as ballooning or surgical repair.…”

“…Injury of relatively large veins, such as the innominate vein or the superior vena cava, can lead to fatal outcomes, which can require emergency interventions such as ballooning or surgical repair. 5,6,8,9 Collier et al…”

“…Several reports have described extravascular malpositioning of the HDC into the mediastinum. The outcomes of these published cases ranged from favorable to fatal 3‐9 . Clinical outcomes or treatment plans for patients with HDC malpositioned into the mediastinum should be considered according to the position of the injured vessels.…”

“…Clinical outcomes or treatment plans for patients with HDC malpositioned into the mediastinum should be considered according to the position of the injured vessels. Injury of relatively large veins, such as the innominate vein or the superior vena cava, can lead to fatal outcomes, which can require emergency interventions such as ballooning or surgical repair 5,6,8,9 . Collier et al evaluated vessel injuries that occurred during central venous catheter insertion and showed that the rate of mortality due to injury to the main vein was 85% 10 .…”

Malpositioned dialysis catheters: A case series

“…The catheter was removed, and the right IJV was secured. Previous studies have reported favorable fatal outcomes after the malpositioning of the HDC into the mediastinum [8][9][10]. Treatment options for complications are primarily based on the position of the injured vessels, the stability of the patient, and available expertise.…”