Li Qi, Liu Yuxiu, Wang Min, Yu Zhongjie, Gao Yufang
Department of Emergency Medicine, The Affiliated Hospital of Qingdao University, Qingdao, China.
School of Medicine, Qingdao University, Qingdao, China.
J Vasc Access. 2021 Nov;22(6):987-991. doi: 10.1177/1129729820938201. Epub 2020 Jul 4.
Persistent left superior vena cava is rare and asymptomatic and is usually discovered incidentally during or after insertion of a central venous catheter. There is uncertainty as to whether or not the catheter should be removed after its malposition resulting in persistent left superior vena cava. We reported an unusual case of a breast cancer patient with a persistent left superior vena cava detected after a peripherally inserted central catheter insertion. The patient had undergone a modified radical mastectomy and needed to insert a peripherally inserted central catheter for chemotherapy. After the peripherally inserted central catheter insertion, the chest X-ray and computed tomography showed that the catheter was located in the persistent left superior vena cava. After an assessment of the persistent left superior vena cava and the catheter tip position, the peripherally inserted central catheter remained in the persistent left superior vena cava for further therapy. To ensure the integrity of the catheter, special follow-ups and tip position observations were carried out. The peripherally inserted central catheter was safe until the end of chemotherapy with no complications. Although the peripherally inserted central catheter tip was located in persistent left superior vena cava, given that the persistent left superior vena cava coexisted with a right superior vena cava with the similar lumen, the peripherally inserted central catheter could be used normally under strict attention.
永存左上腔静脉罕见且无症状,通常在中心静脉导管插入期间或之后偶然发现。对于因导管位置异常导致永存左上腔静脉后是否应拔除导管尚无定论。我们报告了一例乳腺癌患者在经外周静脉穿刺中心静脉置管后发现永存左上腔静脉的罕见病例。该患者接受了改良根治性乳房切除术,需要经外周静脉穿刺中心静脉置管进行化疗。经外周静脉穿刺中心静脉置管后,胸部X线和计算机断层扫描显示导管位于永存左上腔静脉内。在评估永存左上腔静脉和导管尖端位置后,经外周静脉穿刺中心静脉置管保留在永存左上腔静脉内用于进一步治疗。为确保导管完整性,进行了特殊随访和尖端位置观察。经外周静脉穿刺中心静脉置管在化疗结束前一直安全,无并发症。尽管经外周静脉穿刺中心静脉导管尖端位于永存左上腔静脉内,但鉴于永存左上腔静脉与右上腔静脉并存且管腔相似,在严格关注下经外周静脉穿刺中心静脉导管仍可正常使用。