Hu Ying, Gu Fujia, Yuan Ping, Shi Min, Ma Liang, Zha Yan, Fu Ping
Department of Nephrology, Kidney Research Institute, West China Hospital of Sichuan University, Chengdu, China.
Department of Nephrology, People's Hospital of Guizhou Province, Guiyang, China.
Front Med (Lausanne). 2021 Sep 17;8:726120. doi: 10.3389/fmed.2021.726120. eCollection 2021.
The cuff catheter is one of the most common routes of vascular access in hemodialysis patients, while severe complications can occur during cuff catheter placement, such as bleeding, hematoma, and artery or vein damage. During catheterization, brachiocephalic vein perforation associated with a mediastinal lesion is rare. Open chest repair is effective for brachiocephalic vein perforation during catheter placement, but it entails a risk of potentially lethal trauma. Interventional treatment can be considered to reduce injury in this context, but relevant reports are limited. Herein, we describe our experience with a 68-year-old male hemodialyzed patient in whom cuff catheter vascular access was required for regular hemodialysis. He complained of mild pain in the left side of his chest during cuff catheter placement. The surgeon immediately checked the location of the catheter. Digital subtraction angiography revealed that the hemodialysis cuff catheter had punctured the mediastinal area from the left brachiocephalic vein. The patient was diagnosed with left brachiocephalic vein perforation (d ≈ 5 mm). Fortunately, the brachiocephalic vein perforation was successfully repaired with two embolization microcoils after comprehensive assessment and multidisciplinary consultation. Brachiocephalic vein perforation can be repaired with embolization microcoils during hemodialysis catheter placement, and this method of interventional treatment is safe and effective.
袖套导管是血液透析患者最常用的血管通路之一，然而在放置袖套导管过程中可能会出现严重并发症，如出血、血肿以及动脉或静脉损伤。在插管过程中，与纵隔病变相关的头臂静脉穿孔较为罕见。开放性胸部修复术对放置导管期间的头臂静脉穿孔有效，但存在潜在致命创伤的风险。在此情况下可考虑介入治疗以减少损伤，但相关报道有限。在此，我们描述了一名68岁男性血液透析患者的病例经历，该患者因定期血液透析需要进行袖套导管血管通路置入。在放置袖套导管时，他主诉左侧胸部轻度疼痛。外科医生立即检查了导管位置。数字减影血管造影显示血液透析袖套导管从左头臂静脉穿刺进入纵隔区域。该患者被诊断为左头臂静脉穿孔（直径约5毫米）。幸运的是，经过综合评估和多学科会诊后，使用两个栓塞微线圈成功修复了头臂静脉穿孔。在血液透析导管置入过程中，头臂静脉穿孔可用栓塞微线圈修复，这种介入治疗方法安全有效。
