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Persistent left superior vena cava and central venous catheter position: clinical impact illustrated by four cases

  • Radiologic Anatomy
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Abstract

Variations in the course of the blood vessels are often incidental findings during clinical examination. A persistent left superior vena cava (LSVC) is really not rare (healthy individuals, 0.3–0.5%; patients with congenital heart disease, 4%) and serious complications have been described during catheterization in adults with LSVC (shock, cardiac arrest, angina). Therefore variations of the superior vena cava should be considered, especially when central venous catheterization via the subclavian or internal jugular vein is difficult. We describe the embryogenesis and the anatomic variations of persistent LSVC. Subsequently we suggest a classification of superior vena cava according to the positioning of a central venous catheter on the chest radiograph: type I, normal anatomy; type II, only persistent left superior vena cava; type IIIa, right and left superior vena cava with connection; type IIIb, right and left superior vena cava without connection. This classification is illustrated by four clinical cases.

Résumé

Les variations du trajet des vaisseaux sanguins sont souvent des constatations accidentelles au cours de l'examen clinique. Une veine cave supérieure gauche persistante (LSVC) n'est pas vraiment rare (0,3 à 0,5% des individus sains, 4% des patients présentant une cardiopathie congénitale) et de sérieuses complications ont déjà été décrites au cours du cathétérisme d'adultes présentant un LSVC (choc, arrêt cardiaque, angor). C'est pourquoi les variations de la veine cave supérieure devraient être envisagées, particulièrement quand un cathétérisme veineux central par la veine subclavière ou la veine jugulaire interne s'avère difficile. Nous décrivons l'embryogenèse des variétés anatomiques de la veine cave supérieure gauche persistante. Nous suggérons ensuite une classification de la veine cave supérieure selon la position d'un cathéter veineux central sur la radiographie de thorax: type I, anatomie normale; type II, veine cave supérieure gauche persistante isolée; type IIIa, veines caves supérieures droite et gauche reliées l'une à l'autre; type IIIb, veines caves supérieures droite et gauche sans connexion. Cette classification est illustrée par 4 cas cliniques.

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Authors and Affiliations

  1. Clinic for Anesthesiology and Intensive Care Medicine, Friedrich-Schiller University, Bachstrasse 18, 07743, Jena, Germany

    W. Schummer & C. Schummer

  2. Institute of Anatomy I, Friedrich-Schiller University, Teichgraben 7, 07740, Jena, Germany

    R. Fröber

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  1. W. Schummer
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  2. C. Schummer
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  3. R. Fröber
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Correspondence to W. Schummer.

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Schummer, W., Schummer, C. & Fröber, R. Persistent left superior vena cava and central venous catheter position: clinical impact illustrated by four cases. Surg Radiol Anat 25, 315–321 (2003). https://doi.org/10.1007/s00276-003-0138-6

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  • DOI: https://doi.org/10.1007/s00276-003-0138-6

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