Inadvertent through-and-through internal jugular vein penetration and intracarotid placement of a central venous catheter: Microsurgical retrieval technique and operative video

Abstract

Inadvertent carotid cannulation is a rare complication of internal jugular vein (IJV) catheterization, occurring in less than 1% of cases. Given the significant risk of embolic stroke, urgent catheter removal is indicated. In this technical report and operative video, we present our microsurgical technique for the retrieval and removal of an inadvertently placed, transjugular intracarotid central venous catheter (CVC). A 52-year old man presented with sepsis and hemodynamic lability. An attempt to catheterize the left IJV resulted in inadvertent intracarotid CVC placement, following a through-and-through transjugular path. An open microsurgical approach was used to retrieve the CVC and secure local hemostasis, resulting in excellent outcome. Though generally more invasive than percutaneous and endovascular approaches, open surgical retrieval of misplaced intracarotid CVC leads to consistently excellent outcomes, rendering it the preferred approach in the setting of complex catheter trajectories. The technical note and surgical video presented here can serve as a step-by-step guide for performing this procedure, both safely and effectively.