Misplaced hemodialysis catheter in aortic root

A 45-year-old hypertensive female with stage 5 chronic kidney disease was inserted a 15-French double lumen catheter in the right side of neck for hemodialysis but was unable to proceed. On examination, arterial blood flow from the hemodialysis catheter was strongly suggestive of catheter malposition. Chest X ray (Figure 1(a)) showed the apparent position of hemodialysis catheter in right atrium but inconclusive. Computerized tomographic angiogram (Figure 1(b)) showed the transjugular (*) entry of catheter into the right subclavian artery (white arrow) just above bifurcation of innominate artery (#) with the tip placed in the aortic sinus. Patient was heparinized to prevent cerebral thromboembolism before emergent retrieval of catheter followed by right subclavian artery repair through partial sternotomy approach (Figure 1(c)). Postoperative recovery was uneventful with no neurological insult. Misplacement of hemodialysis catheter into intraarterial tree is rare but the timely diagnosis could prevent life-threatening hemorrhage by inadvertent removal of the catheter.

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Figure 1.

(a) Chest X ray showing an apparent right atrial position of dialysis catheter because of overlap of midline vascular structures. (b) Computerized tomographic angiogram coronal maximum intensity projection view showing the transjugular entry of the catheter into the right subclavian artery just above the bifurcation of innominate artery into the aortic sinus. (c) Surgical image showing the catheter entering through and through into the right subclavian artery.