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

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.