Extra-anatomic aorto-right subclavian bypass after complicated insertion of permanent dialysis catheter

Central venous dialysis catheters are the first line of choice to start on hemodialysis. They could be a bridge to establish another dialysis access. Dialysis catheters are essential of two types: temporary (non-tunnelled) and permanent (tunnelled). Insertion of a dialysis catheter is a ubiquitous procedure in renal medicine. One of the rare but serious complications is vascular erosion. We report on a case of a 68-year-old female patient with acute kidney injury who needed emergency hemodialysis. A permanent dialysis catheter was inserted into her right subclavian vein. There was not good flow in the dialysis catheter’s afferent and efferent lumens. The nephrologist performed a contrast chest roentgenoscopy, which showed that the dialysis catheter followed an abnormal course by passing into the ascending aorta. Emergency surgical extraction of the dialysis catheter was initiated using median sternotomy and supraclavicular incision to identify the entry point of the catheter into the subclavian artery. Due to the dissection of the subclavian artery, we performed an extra-anatomic aorto-subclavian bypass with a saphenous vein graft. The dialysis catheter was inserted through open access into the right subclavian vein.