Misplacement of a femoral venous catheter into the ascending lumbar vein: A case report and first use of balloon catheter compression hemostasis.

Rationale: This case report aims to highlight a rare but life-threatening complication of femoral venous catheterization and to describe a novel endovascular technique for its management. Non-tunneled femoral catheters provide rapid vascular access for emergency dialysis (e.g., arteriovenous graft [AVG] occlusion, hyperkalemia) but carry risks of vascular injury, potentially causing fatal bleeding. This is the first report of hemorrhagic shock due to ascending lumbar vein rupture from femoral catheter misplacement, successfully managed by balloon compression hemostasis.

Patient Concerns: A 48-year-old woman with end-stage renal disease presented with hyperkalemia and an occluded AVG. Following ultrasound-guided femoral vein catheterization, she developed recurrent hypotension during dialysis. Suspected anaphylactic shock or abdominal hemorrhage was refractory to anti-allergic therapy, fluid resuscitation, and arterial embolization.

Diagnoses: Digital subtraction angiography (DSA) revealed the catheter tip had perforated the ascending lumbar vein, causing intraperitoneal hemorrhage. DSA clearly identified the injury site and ruled out other causes, confirming hemorrhagic shock secondary to catheter-induced venous rupture.

Interventions: Immediate balloon catheter compression was applied under fluoroscopic guidance. The balloon was precisely positioned at the venous rupture site and inflated to apply direct pressure, sealing the breach for 15 to 20 minutes to promote endothelial repair. This avoided surgical intervention and was particularly suited to this deep, anatomically complex injury.

Outcomes: Post-compression angiography confirmed complete hemostasis. The patient's hemodynamics stabilized immediately, with no further episodes of hypotension. Hemoglobin levels remained stable throughout the remainder of the hospitalization (post-procedure Hb: 65 g/L, discharged with Hb: 95 g/L). Subsequent dialysis sessions were successful without recurrent bleeding. The patient was successfully transitioned to long-term dialysis access. At 1-month postdischarge telephone follow-up, the patient reported no complications and had successfully undergone AVG thrombectomy at another facility.

Lessons: This first report demonstrates the efficacy of interventional balloon compression for catheter-related deep vein rupture, offering a novel strategy for rapid hemostasis. Clinicians must be vigilant for vascular injury during non-tunneled catheter placement, especially in complex areas, and utilize DSA promptly for diagnosis. Further research into standardized protocols and long-term outcomes is warranted.