Delayed presentation of unusual arterial injury during femoral vein catheterization for haemodialysis access

1Regional Nephrology Unit, Level 11, Belfast and 2State Pathology Department, Institute of Forensic Medicine, Belfast, UK The placement of central venous catheters (CVC) has well-recognized complications many of which tend to be more frequent in chronic dialysis patients. The reasons for this include the large calibre of catheters required and the higher number of catheter placements needed [ 2 , 3 ]. In view of the increased risk, various precautionary measures are recommended. We report an unusual type of femoral artery injury that was caused by CVC placement despite adherence to recommended precautions. The case illustrates important learning points. A 78-year-old lady of Chinese origin had been maintained on a regular 3 times weekly haemodialysis therapy for 3 years 8 months. She had presented with bilaterally small kidneys and end stage renal disease. Her co-morbid illnesses were hypertension and ischaemic heart disease. Temporary internal jugular (IJ) catheter placement was needed on a number of occasions at the start of haemodialysis, as her left radiocephalic arteriovenous fistula (AVF) was slow to achieve adequate development. Her small stature and correspondingly small blood vessel calibre made placement of CVCs difficult.