Li Xia, Sun Peng, Ren Wanjun, Guo Shizheng, Wang Xiaoping, Gao Qingzhen
Department of Critical Care Medicine, Jinan Shizhong People's Hospital, Jinan, China.
Department of Nephrology and Blood Purification, Central Hospital Affiliated to Shandong First Medical University, Jinan, China.
Medicine (Baltimore). 2025 Sep 5;104(36):e44472. doi: 10.1097/MD.0000000000044472.
This case report aims to highlight a rare but life-threatening complication of femoral venous catheterization and to describe a novel endovascular technique for its management. Non-tunneled femoral catheters provide rapid vascular access for emergency dialysis (e.g., arteriovenous graft [AVG] occlusion, hyperkalemia) but carry risks of vascular injury, potentially causing fatal bleeding. This is the first report of hemorrhagic shock due to ascending lumbar vein rupture from femoral catheter misplacement, successfully managed by balloon compression hemostasis.
A 48-year-old woman with end-stage renal disease presented with hyperkalemia and an occluded AVG. Following ultrasound-guided femoral vein catheterization, she developed recurrent hypotension during dialysis. Suspected anaphylactic shock or abdominal hemorrhage was refractory to anti-allergic therapy, fluid resuscitation, and arterial embolization.
Digital subtraction angiography (DSA) revealed the catheter tip had perforated the ascending lumbar vein, causing intraperitoneal hemorrhage. DSA clearly identified the injury site and ruled out other causes, confirming hemorrhagic shock secondary to catheter-induced venous rupture.
Immediate balloon catheter compression was applied under fluoroscopic guidance. The balloon was precisely positioned at the venous rupture site and inflated to apply direct pressure, sealing the breach for 15 to 20 minutes to promote endothelial repair. This avoided surgical intervention and was particularly suited to this deep, anatomically complex injury.
Post-compression angiography confirmed complete hemostasis. The patient's hemodynamics stabilized immediately, with no further episodes of hypotension. Hemoglobin levels remained stable throughout the remainder of the hospitalization (post-procedure Hb: 65 g/L, discharged with Hb: 95 g/L). Subsequent dialysis sessions were successful without recurrent bleeding. The patient was successfully transitioned to long-term dialysis access. At 1-month postdischarge telephone follow-up, the patient reported no complications and had successfully undergone AVG thrombectomy at another facility.
This first report demonstrates the efficacy of interventional balloon compression for catheter-related deep vein rupture, offering a novel strategy for rapid hemostasis. Clinicians must be vigilant for vascular injury during non-tunneled catheter placement, especially in complex areas, and utilize DSA promptly for diagnosis. Further research into standardized protocols and long-term outcomes is warranted.
本病例报告旨在强调股静脉置管一种罕见但危及生命的并发症，并描述一种用于处理该并发症的新型血管内技术。非隧道式股静脉导管可为紧急透析（如动静脉内瘘[AVG]闭塞、高钾血症）提供快速的血管通路，但存在血管损伤风险，可能导致致命性出血。这是首例因股静脉导管误置导致腰升静脉破裂引起出血性休克，并通过球囊压迫止血成功处理的报告。
一名48岁终末期肾病女性，因高钾血症和AVG闭塞就诊。在超声引导下进行股静脉置管后，她在透析过程中反复出现低血压。怀疑过敏性休克或腹腔出血，经抗过敏治疗、液体复苏和动脉栓塞均无效。
数字减影血管造影（DSA）显示导管尖端已穿破腰升静脉，导致腹腔内出血。DSA明确了损伤部位并排除了其他病因，证实为导管所致静脉破裂继发的出血性休克。
在透视引导下立即应用球囊导管压迫。将球囊精确置于静脉破裂部位并充气，施加直接压力，封闭破裂口15至20分钟以促进内皮修复。这避免了手术干预，尤其适用于这种深部、解剖结构复杂的损伤。
压迫后血管造影证实完全止血。患者血流动力学立即稳定，未再出现低血压发作。住院剩余时间内血红蛋白水平保持稳定（术后血红蛋白：65g/L，出院时血红蛋白：95g/L）。随后的透析过程顺利，未再出血。患者成功过渡到长期透析通路。出院后1个月电话随访时，患者报告无并发症，且已在另一机构成功进行了AVG血栓切除术。
这篇首例报告证明了介入性球囊压迫治疗导管相关深部静脉破裂的有效性，为快速止血提供了一种新策略。临床医生在非隧道式导管置入过程中，尤其是在复杂区域，必须警惕血管损伤，并及时利用DSA进行诊断。有必要对标准化方案和长期结果进行进一步研究。
