Journal of Nephrology

, Volume 31, Issue 4, pp 571–576 | Cite as

Anatomical variations of the left anonymous trunk are associated with central venous catheter dysfunction

  • Antonio GranataEmail author
  • Luca Zanoli
  • Matteo Trezzi
  • Francesco Londrino
  • Antonio Basile
  • Fulvio Fiorini
  • Biagio Ricciardi
  • Pierpaolo Di Nicolò
  • On behalf of the Integrated Imaging and Nephrologic Interventions Working Group of the Italian Society of Nephrology.
Original Article



Internal jugular vein cannulation has become increasingly widespread. Compared to the left internal jugular vein (LIJV), the right internal jugular vein (RIJV) is the preferred choice for the placement of central venous catheter (CVC) for hemodialysis, mostly due to the major technical difficulties and higher rate of complications of the LIJV approach. We aimed to investigate whether variability in the direction of the LIJV/brachiocephalic vein (BV) axis on the frontal plane could be a decisive factor in determining CVC dysfunctions.


Retrospective cohort study. From our Register, a total of 1489 consecutive patients (age 69 ± 9 years, males 60%) in whom a CVC for hemodialysis was placed from January 2012 to June 2014 were selected.


LIJV cannulation, compared with RIJV, was associated with a higher rate of catheter dysfunction during an observational period of 2 weeks after catheter placement (16 vs.12%; p = 0.005). This complication was strongly correlated with the amplitude of the angle between the LIJV and the ipsilateral BV axis on the frontal plane; an angle ≤ 110° was associated with a higher rate of catheter dysfunction (78 vs.16%; p < 0.001).


The anatomical clarification presented in our study provides useful data that could explain the dysfunction rate of CVC inserted in the LIJV. Clinicians who insert high-flow catheters (such as hemodialysis catheters) should be aware of LIJV/BV axis variability and of the possible risks of CVC dysfunction when the angle between the LIJV and ipsilateral BV is ≤ 110°.


Central venous catheterization Brachiocephalic veins Hemodialysis Complications Anatomical variations Vascular access 


Compliance with ethical standards

Ethical statement

All of the authors have read and approved the manuscript.

Conflict of interest

The authors disclose no relationships with industry and no financial associations and declare the absence of conflicts of interest.


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Copyright information

© Italian Society of Nephrology 2017

Authors and Affiliations

  • Antonio Granata
    • 1
    Email author
  • Luca Zanoli
    • 2
  • Matteo Trezzi
    • 3
  • Francesco Londrino
    • 3
  • Antonio Basile
    • 4
  • Fulvio Fiorini
    • 5
  • Biagio Ricciardi
    • 6
  • Pierpaolo Di Nicolò
    • 7
  • On behalf of the Integrated Imaging and Nephrologic Interventions Working Group of the Italian Society of Nephrology.
  1. 1.Nephrology and Dialysis Unit“St. Giovanni di Dio” HospitalAgrigentoItaly
  2. 2.Nephrology Section, Department of Internal MedicineUniversity of CataniaCataniaItaly
  3. 3.Nephrology and Dialysis Unit“St. Andrea” HospitalLa SpeziaItaly
  4. 4.Radiology Unit“Garibaldi” HospitalCataniaItaly
  5. 5.Nephrology and Dialysis Unit“St. Maria della Misericordia” HospitalRovigoItaly
  6. 6.Nephrology and Dialysis Unit“Fogliani” HospitalMilazzoItaly
  7. 7.Nephrology and Dialysis Unit“St. Maria della Scaletta” HospitalImolaItaly

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