Perforation of the Superior Vena Cava

Abstract

IN 1977, immediate access to the circulation for long-term hemodialysis therapy was made possible by the introduction of a subclavian dialysis catheter.¹While pneumothorax, thrombosis, venous air embolism, catheter fragmentation, infection, or brachial plexus injuries may theoretically complicate the use of this or any other central venous line,^2-6lifethreatening perforation of the superior vena cava (SVC) has been reported only rarely among patients dialyzed with central catheters.^1,7We describe a patient with intrathoracic hemorrhage and cardiopulmonary arrest secondary to the late erosion of a subclavian dialysis catheter through the SVC. <h3>Report of a Case</h3> Acute renal failure developed in a 71-year-old man after the emergency resection of an aortoenteric fistula. On the sixth postoperative day, a Teflon dialysis catheter (20 cm×1.8 mm) was placed uneventfully via a percutaneous left subclavian approach. A chest roentgenogram confirmed proper placement of the catheter in the SVC. Single-needle hemodialysis was then