Letachowicz Krzysztof, Kołodziej Marian, Międzybrodzki Krzysztof, Letachowicz Waldemar, Weyde Wacław, Sąsiadek Marek, Klinger Marian
Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Wroclaw, Poland.
Hemodial Int. 2012 Apr;16(2):310-4. doi: 10.1111/j.1542-4758.2011.00619.x.
Hemodialyzed patients are at risk of multiple catheterizations. Nephrologists performing such procedures need to be familiar with congenital and acquired vascular abnormalities. We describe a successful insertion and use of a cuffed-tunneled catheter in a patient with unusual anatomy of the central venous system. Computed tomography angiography revealed thrombosis of the right subclavian vein and bilateral occlusion of innominate veins. The left internal jugular and subclavian veins joined to form a large vessel that drained through the accessory hemiazygos and azygos veins into the superior vena cava. The catheter was implanted through the left internal jugular vein into the accessory hemiazygos vein. The presented case demonstrates that the catheter can be implanted into distended collateral, especially when no other location is possible.
接受血液透析的患者有多次插管的风险。进行此类操作的肾科医生需要熟悉先天性和后天性血管异常情况。我们描述了在一名中心静脉系统解剖结构异常的患者中成功插入并使用带 cuff 的隧道式导管的情况。计算机断层血管造影显示右锁骨下静脉血栓形成以及无名静脉双侧闭塞。左颈内静脉和左锁骨下静脉汇合形成一条大血管，通过副半奇静脉和奇静脉引流至上腔静脉。导管通过左颈内静脉植入副半奇静脉。该病例表明，导管可植入扩张的侧支血管，尤其是在没有其他可行部位的情况下。
