Shock during hemodialysis due to the penetration and re-entry of the tortuous iliac vein by a double-lumen catheter

A 59-year-old woman with end-stage renal disease underwent ultrasound-guided right femoral double-lumen catheter (DLC) insertion, but shock occurred during hemodialysis. Hemodialysis performed 3 days later via a contralateral DLC also led to shock. Computed tomographic angiography (CTA) clearly revealed penetration and re-entry of the right iliac vein by the DLC. To our knowledge, such complication of indwelling DLC has not been previously documented. CTA offers clear anatomic delineation of such an unusual complication, allowing successful treatment by appropriate compression on penetration and re-entry sites.