A Case Report of Femoral CVC Malposition in Transplant Kidney
A case report has been recently published in BMC Nephrology by Jaka P. and colleagues on the malposition of the femoral central venous catheter in the renal vein of a transplanted kidney, which highlights the importance of careful imaging in patients who have undergone renal transplantation. The complication has been reported only once before, according to the authors, and this clearly indicates that it is a rare complication. Central venous catheterization is a common procedure used for the administration of drugs and fluids, hemodynamic monitoring, and vascular access for extracorporeal therapies. Although it is a safe procedure, complications can arise, especially in patients with altered anatomy, such as those who have undergone renal transplantation.
Kidney transplantation can be performed with the placement of the graft in the right iliac fossa, which alters the normal vascular anatomy of the pelvis. This anatomical variation may predispose patients to unexpected catheter courses during femoral vein cannulation. The current case clearly indicates that even technically successful catheter placement can lead to clinically silent but potentially dangerous malpositions.
The patient was a kidney transplant recipient with the graft in the right iliac fossa who presented with septic shock and a need for urgent central venous access. The right femoral vein was chosen for central venous catheter placement based on clinical urgency. The central venous catheter placement was done without any complications, and the catheter was functioning properly for infusion and monitoring. There were no difficulties with the procedure, resistance during placement, or any immediate complications related to hemodynamics and mechanics. The catheter was used without any problems for two weeks.
Two weeks post-placement, an incidentally noted imaging study revealed that the tip and a significant length of the catheter had been placed into the renal vein of the transplanted kidney instead of being within the central venous circulation as intended. Although the catheter had been malpositioned for a significant period of time, there were no obvious manifestations of acute graft dysfunction at the time of identification. The catheter was repositioned under imaging guidance. The procedure was completed without injury to the graft, and no acute sequelae were observed.
In this single reported case, there was 1 kidney transplant recipient, and 1 femoral central venous catheter was placed via the right femoral vein. There were no complications during placement. The catheter was in place for 2 weeks until imaging studies showed malposition. The tip and a significant portion of the catheter had entered 1 renal vein of the transplanted kidney. The catheter was successfully repositioned by 1 radiologist, and there was no clear graft injury. According to the authors, there is only 1 reported case similar to this in the literature.
Malposition of the femoral central venous catheter in the renal vein of a transplanted kidney is a rare complication, which has been reported only once before. In this case, the malposition of the catheter persisted for 2 weeks without apparent graft injury before the catheter was successfully repositioned under radiologic guidance. This case emphasizes the paramount importance of taking into account the altered anatomy of the kidney transplant recipient.
Reference:
Piletič, J., Kavčič, P. & Škoberne, A. Misplaced femoral vein central venous catheter placed into renal graft vein – a case report. BMC Nephrol (2026). https://doi.org/10.1186/s12882-026-04839-8
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