"Navigating Danger: Emergency Thoracotomy For Superior Vena Cava Injury During Dialysis Access In An Elderly Patient"

Superior vena cava (SVC) injury is a rare but life-threatening complication during the insertion of central venous catheters, especially in elderly patients with multiple comorbidities. We report a case of an 81-year-old woman with a complex medical history, including diabetes mellitus, hypertension, dyslipidemia, and end-stage renal disease (ESRD), who suffered an SVC injury during the placement of a PermCath for hemodialysis. The patient was initially admitted with fever and altered sensorium, requiring urgent dialysis. A femoral catheter was initially used, but a more permanent solution was sought. During the placement of the PermCath, the patient developed hypotension and shock, necessitating immediate transfer to the intensive care unit (ICU). Imaging revealed a severe right hemothorax and active bleeding from a perforation of the SVC. Emergency right exploratory thoracotomy was performed, revealing a 2 cm laceration at the insertion of the azygous vein into the SVC and a linear laceration of the right lower lung lobe. Both injuries were repaired, and the patient was stabilized. She recovered well postoperatively and was discharged on the fifth postoperative day. This case underscores the importance of early recognition and prompt surgical intervention in managing SVC injuries during central venous catheterization