Document Detail

Endovascular management of inadvertent brachiocephalic arterial catheterization.
MedLine Citation:
PMID:  19929193     Owner:  NLM     Status:  MEDLINE    
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.
Ciaran J Powers; Ali R Zomorodi; Gavin W Britz; David S Enterline; Michael J Miller; Tony P Smith
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Publication Detail:
Type:  Journal Article     Date:  2009-11-20
Journal Detail:
Title:  Journal of neurosurgery     Volume:  114     ISSN:  1933-0693     ISO Abbreviation:  J. Neurosurg.     Publication Date:  2011 Jan 
Date Detail:
Created Date:  2011-01-03     Completed Date:  2011-02-01     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0253357     Medline TA:  J Neurosurg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  146-52     Citation Subset:  AIM; IM    
Division of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA.
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MeSH Terms
Aged, 80 and over
Balloon Occlusion
Carotid Artery Injuries*
Catheterization, Central Venous / adverse effects*
Embolization, Therapeutic
Endovascular Procedures / methods*
Follow-Up Studies
Hemorrhage / etiology,  prevention & control
Medical Errors*
Middle Aged
Retrospective Studies
Subclavian Artery / injuries*

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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