I ve encountered a difficult n peculiar situation today during perm cath insertion via left IJV. Pull apart sheath did not go further beyond a particular point (shown in x ray pic). It's lower end got stuck in a blind sac like structure, arising from left brachio cephalic vein. Identified immediately, pt was shifted to OT (C- arm). Guide wire was readjusted, to enter into SVC from left brachio cephalic vein and further procedure continued, to successfully place left IJV perm cath. This could be persistent left superior vena cava (PLSVC), ending blindly at lower end. Thought of sharing it.
