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Endovascular management of inadvertent brachiocephalic arterial catheterization.

Publication ,  Journal Article
Powers, CJ; Zomorodi, AR; Britz, GW; Enterline, DS; Miller, MJ; Smith, TP
Published in: J Neurosurg
January 2011

OBJECT: Inadvertent catheterization of brachiocephalic arteries (carotid artery, subclavian artery, or vertebral artery) during attempted placement of a central venous catheter can have potentially disastrous complications. While removal of the catheter in the operating room is almost always an option, there are circumstances in which a less invasive approach may be more appropriate. The authors present their experience using endovascular techniques for removal of inadvertently placed central venous catheters to elucidate potential options for successful nonsurgical management. METHODS: The authors reviewed their database of interventional procedures that occurred between January 1, 2000, and February 1, 2009. All cases referred for management of suspected brachiocephalic arterial catheterization or arterial injury after attempted placement of a central venous catheter were included. Medical records and radiological imaging were reviewed to determine patient demographics, clinical situation, methods for removal, as well as clinical and imaging follow-up. RESULTS: A total of 13 patients, ranging in age from 31 to 88 years old, were referred to interventional radiology for management of suspected inadvertent arterial catheterization of the brachiocephalic arteries. Angiography confirmed arterial catheterization in 9 patients. Three patients were referred after developing uncontrolled hemorrhage or expanding hematomas following attempted catheterization. One patient who had an arterial waveform after placement of an internal jugular catheter was found to have early venous filling from a dialysis fistula requiring no intervention. Ten patients were treated in the interventional suite using angiographically monitored manual pressure (1 patient), balloon tamponade (3 patients), use of a percutaneous closure device (1 patient), stent grafting (4 patients), or embolization of the injured vessel alone (1 patient). One patient was taken to the operating room for removal of the inadvertently placed catheter due to vessel thrombosis. No procedural complications were encountered, and no patient required sacrifice of a major brachiocephalic vessel. CONCLUSIONS: Angiographic evaluation of patients who underwent inadvertent catheterization of brachiocephalic arteries or their branches allowed successful endovascular treatment or excluded the need for intervention in 12 (92%) of 13 patients. The choice and use of specific endovascular techniques should be dictated by patient factors and the vessel inadvertently catheterized.

Duke Scholars

Published In

J Neurosurg

DOI

EISSN

1933-0693

Publication Date

January 2011

Volume

114

Issue

1

Start / End Page

146 / 152

Location

United States

Related Subject Headings

  • Subclavian Artery
  • Stents
  • Retrospective Studies
  • Neurology & Neurosurgery
  • Middle Aged
  • Medical Errors
  • Male
  • Humans
  • Hemorrhage
  • Follow-Up Studies
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Powers, C. J., Zomorodi, A. R., Britz, G. W., Enterline, D. S., Miller, M. J., & Smith, T. P. (2011). Endovascular management of inadvertent brachiocephalic arterial catheterization. J Neurosurg, 114(1), 146–152. https://doi.org/10.3171/2009.10.JNS09940
Powers, Ciaran J., Ali R. Zomorodi, Gavin W. Britz, David S. Enterline, Michael J. Miller, and Tony P. Smith. “Endovascular management of inadvertent brachiocephalic arterial catheterization.J Neurosurg 114, no. 1 (January 2011): 146–52. https://doi.org/10.3171/2009.10.JNS09940.
Powers CJ, Zomorodi AR, Britz GW, Enterline DS, Miller MJ, Smith TP. Endovascular management of inadvertent brachiocephalic arterial catheterization. J Neurosurg. 2011 Jan;114(1):146–52.
Powers, Ciaran J., et al. “Endovascular management of inadvertent brachiocephalic arterial catheterization.J Neurosurg, vol. 114, no. 1, Jan. 2011, pp. 146–52. Pubmed, doi:10.3171/2009.10.JNS09940.
Powers CJ, Zomorodi AR, Britz GW, Enterline DS, Miller MJ, Smith TP. Endovascular management of inadvertent brachiocephalic arterial catheterization. J Neurosurg. 2011 Jan;114(1):146–152.

Published In

J Neurosurg

DOI

EISSN

1933-0693

Publication Date

January 2011

Volume

114

Issue

1

Start / End Page

146 / 152

Location

United States

Related Subject Headings

  • Subclavian Artery
  • Stents
  • Retrospective Studies
  • Neurology & Neurosurgery
  • Middle Aged
  • Medical Errors
  • Male
  • Humans
  • Hemorrhage
  • Follow-Up Studies