Management of Inadvertent Supra-aortic Arterial Lesions During Central Venous Access Procedures: Report of Six Cases and Proposed Algorithm

Abstract

Accidental supra-aortic arterial cannulation during central venous catheter (CVC) insertion is a rare and serious complication associated with risk of vascular and neurologic complications. The aim of this study is describing our 6 cases experience and propose a management algorithm. We retrospectively evaluated the diagnosis and treatment of six patients arrived at our Department for accidental supra-aortic arterial cannulation during CVC insertion. They underwent Doppler Ultrasonography (DUS) or Computed Tomography Angiography (CTA) to confirm the arterial damage and to decide the correct therapeutic pathway. Four patients underwent DUS as the shallow location of injured arteries and 2 patients CTA because of the arterial damage deeply located. Surgical procedure with direct arterial suture was performed in four patients. Endovascular treatment with stent graft deployment was carried out in two patients. All procedures were conducted successfully: technical success (immediate hemostasis and vessel patency) was obtained in 100% of the cases. Postoperative imaging (DUS or CTA) confirmed the absence of arterial bleeding and the arterial patency. No perioperative mortality or complications occurred. After a careful review of literature and our case series, we proposed an algorithm to delineate the optimal treatment strategy, explaining that early and careful diagnosis (by DUS or CTA) and prompt repair appear crucial to achieve good outcomes and clarifying that an endovascular technique (stent graft placement or vascular closure device) seems to be the best treatment in these cases. Finally, an open surgical technique could be indicated in case of common carotid artery injury and concurrent catheter passing through the target vein.