Endovascular treatment of inadvertent cannulation of the vertebro-subclavian arterial junction.
INTRODUCTION: Inadvertent arterial cannulation at a noncompressible site is a highly risky complication of central venous line placement. SUMMARY OF CASE: We present a case of inadvertent placement of a 6-French venous sheath into the right subclavian artery (SCA) at the origin of the vertebral artery (VA), which was treated successfully using endovascular therapy. RESULTS: Due to the complex site of cannulation, and the patient being fully anticoagulated, the use of a percutaneous closure device was not attempted. Open vascular surgery was not a treatment option due to high surgical risk. After determining left VA dominance, the right VA was occluded distal to the catheter entry point with platinum coils. Subsequently, a covered stent was placed into the SCA across the origin of the VA. The sheath was then removed safely without complications. A minor leak was initially present, which was stopped by repeating balloon inflation within the stent above nominal pressure.
Wolfe, TJ; Smith, TP; Alexander, MJ; Zaidat, OO
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