Document Detail

Experience and technique for the endovascular management of iatrogenic subclavian artery injury.
MedLine Citation:
PMID:  19734007     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Inadvertent subclavian artery catheterization during attempted central venous access is a well-known complication. Historically, these patients are managed with an open operative approach and repair under direct vision via an infraclavicular and/or supraclavicular incision. We describe our experience and technique for endovascular management of these injuries. METHODS: Twenty patients were identified with inadvertent iatrogenic subclavian artery cannulation. All cases were managed via an endovascular technique under local anesthesia. After correcting any coagulopathy, a 4-French glide catheter was percutaneously inserted into the ipsilateral brachial artery and placed in the proximal subclavian artery. Following an arteriogram and localization of the subclavian arterial insertion site, the subclavian catheter was removed and bimanual compression was performed on both sides of the clavicle around the puncture site for 20 min. A second angiogram was performed, and if there was any extravasation, pressure was held for an additional 20 min. If hemostasis was still not obtained, a stent graft was placed via the brachial access site to repair the arterial defect and control the bleeding. RESULTS: Two of the 20 patients required a stent graft for continued bleeding after compression. Both patients were well excluded after endovascular graft placement. Hemostasis was successfully obtained with bimanual compression over the puncture site in the remaining 18 patients. There were no resultant complications at either the subclavian or the brachial puncture site. CONCLUSION: This minimally invasive endovascular approach to iatrogenic subclavian artery injury is a safe alternative to blind removal with manual compression or direct open repair.
N S Cayne; T L Berland; C B Rockman; T S Maldonado; M A Adelman; G R Jacobowitz; P J Lamparello; F Mussa; S Bauer; S S Saltzberg; F J Veith
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Publication Detail:
Type:  Journal Article     Date:  2009-09-05
Journal Detail:
Title:  Annals of vascular surgery     Volume:  24     ISSN:  1615-5947     ISO Abbreviation:  Ann Vasc Surg     Publication Date:  2010 Jan 
Date Detail:
Created Date:  2010-02-03     Completed Date:  2010-04-28     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8703941     Medline TA:  Ann Vasc Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  44-7     Citation Subset:  IM    
Copyright Information:
Copyright 2010 Annals of Vascular Surgery Inc. Published by Elsevier Inc. All rights reserved.
Division of Vascular Surgery, New York University Medical Center, 530 1st Avenue, Suite 6F, New York, NY 10016, USA.
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MeSH Terms
Blood Vessel Prosthesis
Blood Vessel Prosthesis Implantation* / instrumentation
Catheterization, Central Venous / adverse effects*
Hemorrhage / etiology,  radiography,  therapy*
Hemostatic Techniques* / instrumentation
Iatrogenic Disease*
Retrospective Studies
Subclavian Artery / injuries*,  radiography
Time Factors
Treatment Outcome
Wounds, Penetrating / etiology,  radiography,  therapy*

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