Hemorrhagic pericardial tamponade in a hemodialysis patient with catheter-related superior vena cava syndrome: a case report

Zhao, Xiaohong1,2,3; Wang, Kang1,2,3

2024-03-23

10.1186/s13019-024-02624-y

JOURNAL OF CARDIOTHORACIC SURGERY   影响因子和分区

1749-8090

BackgroundIatrogenic complications of endovascular treatment for central venous stenosis have not yet been reported. Here we present a case of a patient on maintenance hemodialysis who developed catheter-related superior vena cava syndrome and subsequently suffered from hemorrhagic pericardial tamponade after undergoing percutaneous transluminal angioplasty and stenting.Case presentationA 72-year-old male patient presented with uremia, and had been receiving maintenance hemodialysis for the past five years. The patient initially presented with dysfunction of the dialysis catheter (a cuffed tunneled double-lumen catheter in the right internal jugular vein). Imaging examination revealed a segmental occlusion of the superior vena cava stretching from the distal end of the dialysis catheter up to right atrium entrance, apparent compensatory dilatation of the azygos vein, and abundant subcutaneous collaterals. The patient underwent percutaneous transluminal balloon dilatation and stenting (covered stent) of the superior vena cava in the Cath Lab. During the procedure, with forceful advancement of the guidewire, it was observed to progress for a distance before a "smoke" appeared, and an outward spillage of contrast agent was visible, which suggested a possible vessel puncture leading into the mediastinum. Unfortunately, postoperative hemorrhagic pericardial tamponade occurred and the patient developed cardiogenic shock. He experienced symptoms included chest tightness and breath shortness with a recorded blood pressure of 84/60mmHg. After draining 600 ml of bloody fluid through pericardiocentesis, the patient's symptoms alleviated and his condition improved.ConclusionsThe case emphasizes the need for increased attention to iatrogenic endovascular injuries during catheter placement and endovascular treatment, such as causing pericardial hemorrhage leading to cardiac tamponade.

Case report Iatrogenic endovascular injuries Superior vena cava syndrome Percutaneous transluminal angioplasty Percutaneous venous stenting

SCI

英语

通讯

Cardiovascular System & Cardiology ; Surgery

Cardiac & Cardiovascular Systems ; Surgery

WOS:001189688000001

BMC

Web of Science

1.Jinan Univ, Shenzhen Peoples Hosp, The Clin Med Coll 2, Dept Nephrol, Guangzhou, Peoples R China
2.Southern Univ Sci & Technol, Affiliated Hosp 1, Shenzhen 518020, Guangdong, Peoples R China
3.Jinan Univ, Shenzhen Peoples Hosp, The Clin Med Coll 2, Shenzhen Key Lab Kidney Dis, Guangzhou, Peoples R China

Zhao, Xiaohong,Wang, Kang. Hemorrhagic pericardial tamponade in a hemodialysis patient with catheter-related superior vena cava syndrome: a case report[J]. JOURNAL OF CARDIOTHORACIC SURGERY,2024,19(1).

Zhao, Xiaohong,&Wang, Kang.(2024).Hemorrhagic pericardial tamponade in a hemodialysis patient with catheter-related superior vena cava syndrome: a case report.JOURNAL OF CARDIOTHORACIC SURGERY,19(1).

Zhao, Xiaohong,et al."Hemorrhagic pericardial tamponade in a hemodialysis patient with catheter-related superior vena cava syndrome: a case report".JOURNAL OF CARDIOTHORACIC SURGERY 19.1(2024).