NG Z1, WONG J1, NANDAKOBAN H1,2, NARAYANAN G1, ARAVINDAN A1, POTTER D1,2
1Liverpool Hospital, South Western Sydney Local Health District, Sydney, Australia, 2University of New South Wales, Sydney, Australia
Background: Congenital vascular anatomical variants pose a challenge to establishing vascular access. Persistent left superior vena cava (PLSVC) is rare but the most common congenital anomaly of the thoracic venous system. We report a case series of three patients with vena caval anomalies encountered at South Western Sydney Local Health District between 2016-2021.
- A 52-year-old man with focal segmental glomerulosclerosis was referred for a tunnelled vascular catheter (TVC) insertion. A left internal jugular vein approach was undertaken due to a right sided pacemaker. The guidewire was initially passed through the left brachiocephalic vein into the inferior vena cava. The catheter was however unable to be advanced past the left brachiocephalic vein. The procedure was abandoned, with CT Venogram confirming presence of a PLSVC.
- A 45-year-old woman with anti-glomerular basement membrane disease was referred for a TVC insertion. During right internal jugular approach the guidewire was repeatedly diverted into the splenic or hepatic vein. Review of previous abdominal imaging confirmed an interrupted inferior vena cava and presence of an enlarged azygous vein. The catheter was successfully tunnelled and utilised.
- A 34-year-old man with an atrial septal defect and anti-glomerular basement membrane disease required vascular access for plasmapheresis. A left internal jugular vein approach was undertaken, with catheter terminating at the left superior vena cava. Fluoroscopy was not employed but real time position was confirmed via chest X-ray and intracavitary ECG. Subsequent vascathogram confirmed catheter placement above the coronary sinus. The TVC was used satisfactorily.
Conclusion: Rare thoracic anatomical variants need to be recognized by interventionalists when difficulties arise, but successful vascular access can be provided in these patients.
Dr Jolene ZL Ng is a Renal Advanced Trainee in Liverpool Hospital, New South Wales, Sydney.