Transjugular Balloon-Assisted Retrograde Ethylene-Vinyl Alcohol Copolymer Embolization of a Main Pulmonary Artery Defect Discovered during Removal of a Malpositioned Dialytic Central Venous Catheter

Abstract

An 81-year-old man was referred for removal of a malpositioned left transjugular tunneled dialysis catheter (TDC; Fig 1). No blood was aspiratable from the catheter. Computerized tomography (CT) confirmed its extravascular course: Its leading segment lay interposed between the descending aorta and left main pulmonary artery (LtMPA). Because the patient was stable and mediastinal bleeding was excluded on contrast-enhanced CT (Fig 2), preemptive embolization of the extravascular route during removal was undertaken. Unexpectedly, the catheter contrast study opacified the LtMPA in communication with left brachiocephalic vein (LtBCV), where the catheter was bent over the artery (Fig 3; Video 1 [available online on the article'sFigure 1. Chest radiographic (a) posteroanterior and (b) lateral views show the anomalous course of TDC directed toward the posterior left side of the mediastinum (arrowheads); a malfunctioning temporary right central venous catheter is present (arrow).