“A 90-year-old man with a long history of hypertension presented with creatinine 10.1mg/dL and pulmonary congestion with pleural effusion on diagnostic imaging. He was diagnosed with end-stage kidney disease due to hypertension, causing volume overload heart failure.

Hemodialysis was initiated via a right internal jugular venous catheter. On catheter occlusion, placement of a new catheter in the left internal jugular vein was performed. The guidewire and catheter insertion proceeded smoothly without resistance, and hemodynamic stability was maintained throughout the procedure. The catheter demonstrated excellent blood flow parameters.

Postprocedural chest radiography revealed an unusual catheter course along the left mediastinal border (Fig 1). Contrast-enhanced computed tomography demonstrated the absence of the left brachiocephalic vein, with the left internal jugular vein joining the left subclavian vein and descending directly to the heart, confirming persistent left superior vena cava (PLSVC) (Fig 2).”

Ito H, Hirose T, Mori T. Unusual Central Venous Catheter Position in Hemodialysis: Anatomical Considerations. Kidney Med. 2025 Apr 16;7(6):101006. doi: 10.1016/j.xkme.2025.101006. PMID: 40510607; PMCID: PMC12152609.