Vascular access dysfunction associated with type 3 persistent left superior vena cava in an adult patient. Case report

Introduction: Persistent left superior vena cava (PLSVC) is a congenital venous anomaly with an estimated prevalence of 0.5% in the adult population. This condition is usually asymptomatic, does not require treatment, and is usually diagnosed incidentally. However, knowledge of its occurrence is essential for the proper planning of some procedures and surgeries. Case report: A 59-year-old man with stage 5 chronic kidney disease was referred to the Hospital Universitario Nacional de Colombia due to central venous hemodialysis catheter dysfunction (right jugular vein). A new central venous catheter was inserted in the left jugular vein, but it failed shortly after, so imaging studies were performed (chest X-ray and CT angiography), detecting type 3 PLSVC draining into the left atrium. Considering this finding and the fact that the CT angiography showed no signs of obstruction in the right jugular vein, the catheter was removed from the left jugular vein and a new one was placed in the right jugular vein, which allowed continuing hemodialysis without complications and discharging the patient 24 days after his admission to hospital. Conclusions: Although PLSVC is a rare anomaly, especially type 3, its diagnosis is usually incidental, as in the case of the patient described here. Knowledge of vascular anomalies in patients with chronic kidney disease is fundamental, given that it allows selecting the proper vascular access and reducing the risk of complications such as arrhythmia, thrombosis, or even perforation of the heart. This case report is highly relevant since blood flow to the heart and lungs may be altered in patients with PLSVC, and this may require hemodynamic adjustments during hemodialysis and in the follow-up of this population.