The vascular access angiography showed a large stenosis of the left brachiocephalic vein close to its contribution to the superior vena cava (Figure 2), obviously at the contact point with the tip of the initially introduced temporary right subclavian catheter.
In our case, the right subclavian catheter tip, lead in a straight route through the right brachiocephalic vein, could be in contact and cause injury to the left brachiocephalic vein endothelium at the point near to its junction to the superior vena cava.
In our case, the mechanism of intima damage from the blood flow turbulence obviously contributed to the stenosis, due to the proximity or contact of the tip of the right subclavian catheter to the left brachiocephalic vein endothelium at the point near to its junction to the superior vena cava.
In 53 % of cadavers the left superior intercostal vein communicated with the azygos system, either directly without communicating with the AHV (7 % of cadavers) or via the AHV with or without communicating with the AV (46 % of cadavers): it drained into the left brachiocephalic vein in all cadavers.
MAGNETIC RESONANCE ANGIOGRAPHY: Magnetic resonance angiography (MRA) is an accurate, noninvasive method for detecting thrombus in the central thoracic veins, such as the SVC and brachiocephalic veins. It correlates extremely well with venography and provides more complete evaluation of central collaterals, all central veins, including contralateral vessels, and blood flow.