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Review
. 2024 Apr 20;19(1):259.
doi: 10.1186/s13019-024-02708-9.

On the way to the azygos vein: a road of return rather than ruined

Yiping Feng  1   2 , Yeqing Liu  3 , Shanxiang Xu  1   2 , Huiming Zhong  1   2 , Shouyin Jiang  4   5
Affiliations
Review

On the way to the azygos vein: a road of return rather than ruined

Yiping Feng et al. J Cardiothorac Surg. .

Abstract

Background: The malposition of central venous catheters (CVCs) may lead to vascular damage, perforation, and even mediastinal injury. The malposition of CVC from the right subclavian vein into the azygos vein is extremely rare. Here, we report a patient with CVC malposition into the azygos vein via the right subclavian vein. We conduct a comprehensive review of the anatomical structure of the azygos vein and the manifestations associated with azygos vein malposition. Additionally, we explore the resolution of repositioning the catheter into the superior vena cava by carefully withdrawing a specific length of the catheter.

Case presentation: A 79-year-old female presented to our department with symptoms of complete intestinal obstruction. A double-lumen CVC was inserted via the right subclavian vein to facilitate total parenteral nutrition. Due to the slow onset of sedative medications during surgery, the anesthetist erroneously believed that the CVC had penetrated the superior vena cava, leading to the premature removal of the CVC. Postoperative contrast-enhanced computed tomography of the chest confirmed that the central venous catheter had not penetrated the superior vena cava but malpositioned into the azygos vein. The patient was discharged 15 days after surgery without any complications.

Conclusions: CVC malposition into the azygos vein is extremely rare. Clinical practitioners should be vigilant regarding this form of catheter misplacement. Ensuring the accurate positioning of the CVC before each infusion is crucial. Utilizing chest X-rays in both frontal and lateral views, as well as chest computed tomography, can aid in confirming the presence of catheter misplacement.

Keywords: Azygos vein; Central venous catheter; Malposition.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
(A) Chest radiograph showing a central venous catheter inserted via the right subclavian vein and the catheter kinking at the right tracheobronchial angle (red arrows); (B) Axial slice from the chest CT scan shows the catheter tip projecting from the posterior wall of the superior vena cava (red arrow); (C) The CVC deviated anteriorly towards the thoracic vertebrae (red arrow); (D) Post-operative contrast-enhanced chest CT revealed no pleural effusion or mediastinal fluid accumulation
Fig. 2
Fig. 2
Anatomic illustration showing the course of the azygos vein and the aberrant trajectory of the central venous catheter
See this image and copyright information in PMC

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References

    1. Bell T, O’Grady NP. Prevention of Central Line-Associated Bloodstream infections. Infect Dis Clin North Am. 2017;31(3):551–9. doi: 10.1016/j.idc.2017.05.007. - DOI - PMC - PubMed
    1. Baskin JL, Pui CH, Reiss U, et al. Management of occlusion and thrombosis associated with long-term indwelling central venous catheters. Lancet. 2009;374(9684):159–69. doi: 10.1016/S0140-6736(09)60220-8. - DOI - PMC - PubMed
    1. Roldan CJ, Paniagua L. Central venous catheter intravascular malpositioning: causes, Prevention, diagnosis, and correction. West J Emerg Med. 2015;16(5):658–64. doi: 10.5811/westjem.2015.7.26248. - DOI - PMC - PubMed
    1. NATHAN H Anatomical observations on the course of the azygos vein (vena azygos major) Thorax. 1960;15(3):229–32. doi: 10.1136/thx.15.3.229. - DOI - PMC - PubMed
    1. Haygood TM, Malhotra K, Ng C, Chasen B, McEnery KW, Chasen M. Migration of central lines from the superior vena cava to the azygous vein. Clin Radiol. 2012;67(1):49–54. doi: 10.1016/j.crad.2011.05.011. - DOI - PubMed

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