title: Conservative management of iatrogenic superior vena cava (SVC) perforation after attempted dialysis catheter placement: case report and literature review.
abstract: A 68-year-old male with end-stage renal disease, congestive heart failure, and facial and bilateral arm swelling was referred for placement of a tunneled dialysis catheter. Distal left subclavian vein access was obtained. The procedure was complicated by iatrogenic perforation of the superior vena cava (SVC). This resulted in rapid development of a right-sided hemothorax and hemodynamic instability. A right-sided thoracostomy tube was placed to drain the pleural cavity. Extrapericardial perforation of the SVC can be managed conservatively in select cases without endovascular balloon dilatation and/stent graft deployment or surgical repair provided the antegrade blood flow is maintained via patent collateral circulation.
authors.affiliation: Department of Radiology, Division of Vascular and Interventional Radiology, Boston Medical Center, 88 East Newton Street, Boston, MA-02118. Electronic address: niikabu@gmail.com.
authors.forename: Nii-Kabu
authors.initials: NK
authors.lastname: Kabutey
authors.forename: Neeraj
authors.initials: N
authors.lastname: Rastogi
authors.forename: Ducksoo
authors.initials: D
authors.lastname: Kim
mesh_terms: D006439:Hemodynamics; D006491:Hemothorax / Q000209:etiology / Q000601:surgery; D006801:Humans; D007049:Iatrogenic Disease; D007676:Kidney Failure, Chronic / Q000628:therapy*; D008297:Male; D006435:Renal Dialysis / Q000009:adverse effects*; D015607:Stents; D013907:Thoracostomy; D062666:Vascular Access Devices / Q000009:adverse effects*; D014652:Vascular Diseases / Q000209:etiology / Q000628:therapy*; D014683:Vena Cava, Superior / Q000293:injuries*
keywords: Dialysis access; SVC obstruction; SVC perforation; Stent graft