title: Dialysis catheter placement via the left internal jugular vein: risk of brachiocephalic vein perforation.
abstract: OBJECTIVE
  We discuss a case of a brachiocephalic vein (BCV) perforation after Tesio® central venous catheter insertion.
  
  
  RESULTS
  An 80-year-old patient underwent an ultrasound-guided hemodialysis (HD) catheter placement via his left internal jugular vein (IJV). One day postoperatively, the patient became hemodynamically unstable immediately after HD initiation. As a vascular event was feared, an emergency CT scan was performed demonstrating a BCV perforation. The patient underwent a sternotomy, the lines were removed and the venous laceration was closed. The patient recovered well.
  
  
  CONCLUSIONS
  In spite of ultrasound guidance, fluoroscopy for guidewire and sheath advancement, venous blood aspiration and a normal appearing postoperative x-ray, traumatic central venous catheter placement is still possible. Tenting of the BCV wall during catheter advancement possibly caused the venous perforation. A 'how-to' for correct catheter placement via the IJV is provided and potential pitfalls during each procedural step are discussed.
authors.affiliation: Department of Vascular Surgery, Máxima Medical Center, Veldhoven - The Netherlands.
authors.forename: Michiel B
authors.initials: MB
authors.lastname: Winkes
authors.affiliation: Department of Vascular Surgery, Máxima Medical Center, Veldhoven - The Netherlands.
authors.forename: Maarten J
authors.initials: MJ
authors.lastname: Loos
authors.affiliation: Department of Vascular Surgery, Máxima Medical Center, Veldhoven - The Netherlands.|CARIM Research School, Maastricht University, Maastricht - The Netherlands.
authors.forename: Marc R
authors.initials: MR
authors.lastname: Scheltinga
authors.affiliation: CARIM Research School, Maastricht University, Maastricht - The Netherlands.|Cardiovascular Center, Catharina Hospital, Eindhoven - The Netherlands.
authors.forename: Joep A
authors.initials: JA
authors.lastname: Teijink
mesh_terms: D000369:Aged, 80 and over; D016121:Brachiocephalic Veins / Q000000981:diagnostic imaging / Q000293:injuries* / Q000503:physiopathology / Q000601:surgery; D002405:Catheterization, Central Venous / Q000009:adverse effects* / Q000295:instrumentation; D002408:Catheters, Indwelling; D062905:Central Venous Catheters; D000072226:Computed Tomography Angiography; D020878:Device Removal; D004867:Equipment Design; D006439:Hemodynamics; D006801:Humans; D007601:Jugular Veins / Q000000981:diagnostic imaging / Q000503:physiopathology; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000628:therapy*; D008297:Male; D010690:Phlebography / Q000379:methods; D015641:Radiography, Interventional; D012039:Regional Blood Flow; D006435:Renal Dialysis; D012307:Risk Factors; D056346:Sternotomy; D013536:Suture Techniques; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional; D057772:Vascular System Injuries / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology / Q000601:surgery