PMC8484305_01
The tip of the hemodialysis cuff catheter could not reach the upper 1/3 of the right atrial position.
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F1
DSA analysis revealed that the tip of the catheter could not reach the upper 1/3 of the right atrium (the tip of the catheter was in this position, which can meet the requirements of hemodialysis, as shown in Figure 1).
DSA revealed that the hemodialysis catheter had penetrated the brachiocephalic vein into the mediastinum (A). The diameter of the vascular rupture was approximately 5 mm (B). The catheter was drawn out slowly, and the vascular rupture was blocked with two embolization coils (C). The catheter was returned to the lumen of the brachiocephalic vein, the perforation was blocked, and there was no bleeding (D).
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F2
The next day attempts were made to adjust the catheter via a rotating method, but during that process, the catheter pierced the brachiocephalic vein and entered the mediastinum (Figure 2A). Because the patient had no hematoma formation and the rupture was small (d   5 mm; Figure 2B), and based on the experience of interventional doctors, an embolization microcoil was used to fix the perforation with the assistance of a vascular surgeon (Figures 2C,D).
Two embolization microcoils (COOK d   5 mm) were inserted to block the vascular rupture (A), and X-ray revealed that the cuff catheter and embolization microcoil were appropriately located in the brachiocephalic vein (B).
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F3
The catheter was successfully replaced as shown in Figure 3A. The patient could then continue to undergo hemodialysis via the left cuff catheter (Figure 3B).