Accidental insertion of a percutaneous venovenous cannula into the persistent left superior vena cava of a patient undergoing liver transplantation

Kristin L. Schreiber, Takashi Matsusaki, Brian C. Bane, Christian A. Bermudez, Ibtesam A. Hilmi, Tetsuro Sakai

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Purpose: Persistent left superior vena cava (PLSVC) is a rare congenital vascular abnormality found in 0.3% of the general population. We report herein a rare complication involving the accidental insertion of a large bore cannula into the PLSVC during liver transplantation (LT). Clinical features: A 63-yr-old man with primary sclerosing cholangitis presented for LT. Given the existence of a tunnelled dialysis catheter in the right internal jugular vein (IJV) and a triple lumen catheter via the left IJV, insertion of an 18 French cannula for venovenous bypass (VVB) was performed via the left IJV using the existing triple lumen cannula as a conduit for a guidewire. Upon initiation of VVB, profound systemic hypotension occurred, and liver transplantation was completed without the further use of VVB. A chest x-ray confirmed a malposition of the VVB cannula with a large left hemothorax. A mini-sternotomy was performed for removal of the VVB cannula, which was found to be inserted in the PLSVC. Retrospectively, the presence of PLSVC was not anticipated due to a normal superior vena cava and a left innominate vein, as revealed by the course of a pre-existing left internal jugular vein triple lumen catheter on a preoperative chest x-ray, and due to a normal-sized coronary sinus on preoperative echocardiography. Conclusion: Malpositioning of a venous cannula in a PLSVC should be anticipated as one of the potential complications of vascular access via the left internal jugular vein.

Original languageEnglish
Pages (from-to)646-649
Number of pages4
JournalCanadian Journal of Anesthesia
Volume58
Issue number7
DOIs
Publication statusPublished - Jul 2011
Externally publishedYes

Fingerprint

Superior Vena Cava
Liver Transplantation
Jugular Veins
Catheters
Blood Vessels
Thorax
X-Rays
Brachiocephalic Veins
Hemothorax
Sclerosing Cholangitis
Sternotomy
Coronary Sinus
Hypotension
Echocardiography
Cannula
Dialysis
Population

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Cite this

Accidental insertion of a percutaneous venovenous cannula into the persistent left superior vena cava of a patient undergoing liver transplantation. / Schreiber, Kristin L.; Matsusaki, Takashi; Bane, Brian C.; Bermudez, Christian A.; Hilmi, Ibtesam A.; Sakai, Tetsuro.

In: Canadian Journal of Anesthesia, Vol. 58, No. 7, 07.2011, p. 646-649.

Research output: Contribution to journalArticle

Schreiber, Kristin L. ; Matsusaki, Takashi ; Bane, Brian C. ; Bermudez, Christian A. ; Hilmi, Ibtesam A. ; Sakai, Tetsuro. / Accidental insertion of a percutaneous venovenous cannula into the persistent left superior vena cava of a patient undergoing liver transplantation. In: Canadian Journal of Anesthesia. 2011 ; Vol. 58, No. 7. pp. 646-649.
@article{2b4dd929195c467bb48e97ee8f35d0cf,
title = "Accidental insertion of a percutaneous venovenous cannula into the persistent left superior vena cava of a patient undergoing liver transplantation",
abstract = "Purpose: Persistent left superior vena cava (PLSVC) is a rare congenital vascular abnormality found in 0.3{\%} of the general population. We report herein a rare complication involving the accidental insertion of a large bore cannula into the PLSVC during liver transplantation (LT). Clinical features: A 63-yr-old man with primary sclerosing cholangitis presented for LT. Given the existence of a tunnelled dialysis catheter in the right internal jugular vein (IJV) and a triple lumen catheter via the left IJV, insertion of an 18 French cannula for venovenous bypass (VVB) was performed via the left IJV using the existing triple lumen cannula as a conduit for a guidewire. Upon initiation of VVB, profound systemic hypotension occurred, and liver transplantation was completed without the further use of VVB. A chest x-ray confirmed a malposition of the VVB cannula with a large left hemothorax. A mini-sternotomy was performed for removal of the VVB cannula, which was found to be inserted in the PLSVC. Retrospectively, the presence of PLSVC was not anticipated due to a normal superior vena cava and a left innominate vein, as revealed by the course of a pre-existing left internal jugular vein triple lumen catheter on a preoperative chest x-ray, and due to a normal-sized coronary sinus on preoperative echocardiography. Conclusion: Malpositioning of a venous cannula in a PLSVC should be anticipated as one of the potential complications of vascular access via the left internal jugular vein.",
author = "Schreiber, {Kristin L.} and Takashi Matsusaki and Bane, {Brian C.} and Bermudez, {Christian A.} and Hilmi, {Ibtesam A.} and Tetsuro Sakai",
year = "2011",
month = "7",
doi = "10.1007/s12630-011-9510-x",
language = "English",
volume = "58",
pages = "646--649",
journal = "Canadian Journal of Anaesthesia",
issn = "0832-610X",
publisher = "Springer New York",
number = "7",

}

TY - JOUR

T1 - Accidental insertion of a percutaneous venovenous cannula into the persistent left superior vena cava of a patient undergoing liver transplantation

AU - Schreiber, Kristin L.

AU - Matsusaki, Takashi

AU - Bane, Brian C.

AU - Bermudez, Christian A.

AU - Hilmi, Ibtesam A.

AU - Sakai, Tetsuro

PY - 2011/7

Y1 - 2011/7

N2 - Purpose: Persistent left superior vena cava (PLSVC) is a rare congenital vascular abnormality found in 0.3% of the general population. We report herein a rare complication involving the accidental insertion of a large bore cannula into the PLSVC during liver transplantation (LT). Clinical features: A 63-yr-old man with primary sclerosing cholangitis presented for LT. Given the existence of a tunnelled dialysis catheter in the right internal jugular vein (IJV) and a triple lumen catheter via the left IJV, insertion of an 18 French cannula for venovenous bypass (VVB) was performed via the left IJV using the existing triple lumen cannula as a conduit for a guidewire. Upon initiation of VVB, profound systemic hypotension occurred, and liver transplantation was completed without the further use of VVB. A chest x-ray confirmed a malposition of the VVB cannula with a large left hemothorax. A mini-sternotomy was performed for removal of the VVB cannula, which was found to be inserted in the PLSVC. Retrospectively, the presence of PLSVC was not anticipated due to a normal superior vena cava and a left innominate vein, as revealed by the course of a pre-existing left internal jugular vein triple lumen catheter on a preoperative chest x-ray, and due to a normal-sized coronary sinus on preoperative echocardiography. Conclusion: Malpositioning of a venous cannula in a PLSVC should be anticipated as one of the potential complications of vascular access via the left internal jugular vein.

AB - Purpose: Persistent left superior vena cava (PLSVC) is a rare congenital vascular abnormality found in 0.3% of the general population. We report herein a rare complication involving the accidental insertion of a large bore cannula into the PLSVC during liver transplantation (LT). Clinical features: A 63-yr-old man with primary sclerosing cholangitis presented for LT. Given the existence of a tunnelled dialysis catheter in the right internal jugular vein (IJV) and a triple lumen catheter via the left IJV, insertion of an 18 French cannula for venovenous bypass (VVB) was performed via the left IJV using the existing triple lumen cannula as a conduit for a guidewire. Upon initiation of VVB, profound systemic hypotension occurred, and liver transplantation was completed without the further use of VVB. A chest x-ray confirmed a malposition of the VVB cannula with a large left hemothorax. A mini-sternotomy was performed for removal of the VVB cannula, which was found to be inserted in the PLSVC. Retrospectively, the presence of PLSVC was not anticipated due to a normal superior vena cava and a left innominate vein, as revealed by the course of a pre-existing left internal jugular vein triple lumen catheter on a preoperative chest x-ray, and due to a normal-sized coronary sinus on preoperative echocardiography. Conclusion: Malpositioning of a venous cannula in a PLSVC should be anticipated as one of the potential complications of vascular access via the left internal jugular vein.

UR - http://www.scopus.com/inward/record.url?scp=79960456430&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=79960456430&partnerID=8YFLogxK

U2 - 10.1007/s12630-011-9510-x

DO - 10.1007/s12630-011-9510-x

M3 - Article

VL - 58

SP - 646

EP - 649

JO - Canadian Journal of Anaesthesia

JF - Canadian Journal of Anaesthesia

SN - 0832-610X

IS - 7

ER -