Long-term follow-up of endovascular repair of iatrogenic superior vena cava injury: A case report

Physician-Modified Fenestrated Endovascular Repair for Iatrogenic Innominate Vein Injury

Iatrogenic innominate vein injuries are rare complications associated with internal jugular venous catheters. These complications are accompanied by high morbidity and mortality rates in patients with severe underlying medical conditions. Without proper treatment, emergency surgery may be needed due to acute cardiac tamponade or hemothorax. Endovascular repair can be advantageous for patients with significant medical comorbidities. Herein, we report the case of a 62-year-old female with an iatrogenic injury to the innominate vein at the subclavian vein and internal jugular confluence due to a malpositioned left internal jugular catheter. A customized fenestrated endograft was positioned with fenestration oriented to the internal jugular vein and a new tunneled catheter was inserted across the fenestration into the superior vena cava upon removal of the malpositioned catheter. In addition, a brachio-basilic arteriovenous fistula was created. At one month follow-up, the patient had a palpable thrill over the arteriovenous fistula and a functioning tunneled catheter.

Bleeding of the Superior Vena Cava Due to an Iatrogenic Injury to It during the Ultrasound-Guided Central Venous Cannulation

Central venous cannulation (CVC) is a procedure that is frequently performed to facilitate resuscitation, nutritional support and long-term vascular access. It may often cause mechanical complications during placement of a cannula in association with the anatomical relationship with central veins. A 68-year-old man visited our medical institution with a chief complaint of foreign-body-induced esophageal perforation. This patient presented with bleeding of the superior vena cava due to an iatrogenic injury to it during the CVC in the right internal jugular vein. Our case indicates that it would be mandatory to insert a cannula at an optimal depth considering the anatomical relationship between the central veins during the CVC.