Abstract
Accidental arterial puncture occurs in around 1% and 2.7% of jugular and subclavian
approaches, respectively. When a line has been inadvertently inserted into an artery
at a noncompressible site, there is an increased risk for serious complications. This
complication can be treated by either surgical or endovascular intervention or a combination;
however, in critically ill patients or in those with impaired coagulation, therapeutic
options are more limited. We describe successful endovascular management of inadvertent
subclavian artery cannulation during insertion of a triple lumen central line catheter
in a 35-year-old man suffering from leukemia, with sepsis and multi-organ failure.
He was hypotensive and hemodynamically unstable, with severe coagulopathy. The catheter
had entered the artery at the level of the origin of the internal mammary artery,
just above the origin of the vertebral artery. The tip was lying in the aortic arch.
The artery was successfully closed by endovascular deployment of an 8 French Angio-Seal
device (St. Jude Medical, St. Paul, MN, USA). The device is licensed for use in femoral
arterial puncture sites but provided safe and effective closure of the subclavian
artery puncture in our patient.
Keywords
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References
- Complications and failures of subclavian-vein catheterization.N Engl J Med. 1994; 331: 1735-1738
- Aberrant locations and complications in initial placement of subclavian vein catheters.Arch Surg. 1984; 119: 293-295
- Avoiding common technical errors in subclavian central venous catheter placement.J Am Coll Surg. 2009; 208: 104-109
- Mechanical complications of central venous catheters.J Intensive Care Med. 2006; 21: 40-46
- Central venous catheterization: complications of different placements.. 2001; 126: 1001-1006
- Subclavian stents and stent-grafts: cause for concern?.J Endovasc Surg. 1999; 6: 223-226
- Outcome and safety of same-day-discharge percutaneous coronary interventions with femoral access: a single-center experience.Am Heart J. 2013; 165: 393-399
- Efficacy and safety of the angioseal vascular closure device post antegrade puncture.Cardiovasc Intervent Radiol. 2008; 31: 558-562
- The efficacy and safety of closure of brachial access using the AngioSeal closure device: experience with 161 interventions in diabetic patients with critical limb ischemia.J Vasc Surg. 2008; 47: 782-788
- Inadvertent subclavian artery cannulation: endovascular repair using a collagen closure device-report of two cases and review of the literature.Case Rep Vasc Med. 2012; 2012: 150343
- Misplacement of central venous catheters in the subclavian artery: safe retrieval with a percutaneous closure device (AngioSeal).Rofo. 2013; 185: 546-549
- Delayed percutaneous closure of the subclavian artery after inadvertent placement of a hemodialysis catheter.J Vasc Access. 2012; 13: 266
Article info
Publication history
Published online: May 09, 2014
Accepted:
April 21,
2014
Received:
April 13,
2014
Identification
Copyright
© 2014 Elsevier Ltd. Published by Elsevier Inc. All rights reserved.
