Three-dimensional Anatomy of the Left Central Veins: Implications for Dialysis Catheter Placement

Purpose: To define the three-dimensional anatomy of the left central veins and the implication for left-sided dialysis catheter placement. Materials and Methods: Images from 30 consecutive patients undergoing computed tomography (CT) pulmonary angiography were reconstructed to depict the central venous anatomy. The reconstructed images were analyzed for parameters that could influence dialysis catheter placement. In particular, the cross-sectional diameters of the left brachiocephalic vein were measured, as well as the angulation between the left internal jugular vein and brachiocephalic vein, the angulation between left brachiocephalic vein and superior vena cava, and the angulation of the left brachiocephalic vein in the axial plane as it crosses the mediastinum. Results: The cross-sectional diameters of the left brachiocephalic vein did not change significantly as it traversed the mediastinum. The mean cross-sectional diameters were 11 (±5.2) × 12 (±5.1) mm for the peripheral, 13 (±5.0) × 13 (±4.8) mm for the mid, and 13 (±4.6) × 14 (±4.5) mm for the central left brachiocephalic vein. The angulation between the left internal jugular and brachiocephalic vein measured 117 degrees (±11), the angulation between the left brachiocephalic vein and the superior vena cava measured 116 degrees (±7), and the angulation of the left brachiocephalic vein as it traverses the aorta and left brachiocephalic artery measured 106 degrees (±9). Conclusions: A sharp angulation of the left brachiocephalic vein as it drapes over the aorta or arch vessels is a common anatomic finding. This angulation is not apparent on frontal projection radiographs or venograms. A hemodialysis catheter torqued over this angulation could contact the vessel wall and lead to endothelial irritation. Further study may help define whether this contributes to the higher complication rates associated with left-sided catheters.