Subclavian Artery Catheterization Research Articles

Accidental Subclavian Artery Catheterization After Central Venous Catheter Placement

Accidental Subclavian Artery Catheterization After Central Venous Catheter Placement

Successful endovascular management of inadvertent catheterization of subclavian artery

Successful endovascular management of inadvertent catheterization of subclavian artery

Unusual complications of the central venous catheterization in trauma patients

Central venous catheters (CVCs) are commonly used in patients with trauma. The placement and removal of the CVCs can result in various complications regardless of the skill of the professionals. Herein, two cases of rare complications are presented— an inadvertent subclavian artery catheterization and a cerebral air embolism after a CVC removal. Moreover, practical solutions for each complication are provided in detail.

Avoiding Arch Manipulation with Catheterization of Left Subclavian Artery for Endovascular Repair of Distal Descending Aorta: Acibadem Technique.

Although thoracic endovascular aortic repair (TEVAR) is associated with reduced mortality and shorter hospital stay compared to open surgery, the decrease in stroke risk did not reach the desired rates. Aortic arch manipulation is one of the main concerns leading to stroke during TEVAR. Here, we describe a new technique called "Acibadem Technique" to avoid arch and ascending aorta manipulation with catheterization of left subclavian artery for endovascular distal descending aortic repair.

Inadvertent Subclavian Artery Catheterization: Juxta-Catheter Thrombosis with Subsequent Stroke

Inadvertent Subclavian Artery Catheterization: Juxta-Catheter Thrombosis with Subsequent Stroke

Treatment of inadvertent subclavian artery cannulation with a percutaneous vascular closure device

Inadvertent puncture of the subclavian artery is an uncommon but potentially fatal complication of the commonly performed internal jugular vein catheterization. We report a case of accidental subclavian artery catheterization close to the vertebral artery during internal jugular venous cannulation, which was successfully managed in the interventional suite with catheter removal and use of a vascular closure device.

Efficacy and Safety of a Novel Catheter for Transradial Cerebral Angiography

The goal of this study is to evaluate the safety and efficacy of a novel catheter for right radial artery approach cerebral angiography. Patients from the Neurology Department of The Second Affiliated Hospital of Guangxi Traditional Chinese Medical University who underwent diagnostic cerebral angiography of either the left vertebral artery dominant type or balanced type were enrolled in this study. A total of 167 patients were treated between February 2016 and December 2017, of whom 44 were excluded based on study exclusion criteria and 123 were enrolled in the present analysis. Bilateral subclavian artery catheterization and bilateral common carotid artery catheterization were conducted successfully in all 123 patients. The success rate of selective catheterization of the left vertebral artery was 87.8% (108/123). The success rate of selective catheterization of the right vertebral artery using the novel catheter was 89.0% (73/82). The average fluoroscopy time was 6.5±3.4min, the average operation duration was 47±3.7 (range 50-90) min, and the average dosage of contrast agent was 112.3±8.1mL. One patient exhibited an absence of pulse in the punctual radial artery after the removal of the arterial compression band, but there was no evidence of ischemia of the distal hand. One patient who was undergoing dual anti-platelet drug treatment suffered from bleeding at the puncture point when deflated for 2hr after operation; this patient was re-pressurized and re-timed. This novel catheter improved the success rate of selective left vertebral artery catheterization, and allowed for simplification of the relevant surgical steps. The controllability of this novel catheter was satisfactory, and its associated surgical risk was found to be low.

Endovascular Repair Using Suture-Mediated Closure Devices and Balloon Tamponade following Inadvertent Subclavian Artery Catheterization with Large-Caliber Hemodialysis Catheter.

Accidental subclavian artery cannulation is an uncommon but potentially serious complication of central venous catheterization. Removal of a catheter inadvertently placed in the subclavian artery can lead to substantial bleeding, as achieving hemostasis in this area through manual compression presents considerable difficulty. Additionally, surgical treatment might be unsuitable for high-risk patients due to comorbidities. Here, we report a case of an inadvertently-inserted 11.5-French hemodialysis catheter in the subclavian artery during internal jugular venous catheterization. We performed percutaneous closure of the subclavian artery using three 6-French Perclose Proglide® devices with a balloon tamponade in the proximal part of the subclavian artery. Closure was completed without embolic neurological complications.

Balloon tamponade repair after inadvertent subclavian artery catheterization.

The approach to repair inadvertent subclavian artery catheterization has evolved to increasingly less invasive modalities. Most recently, endovascular balloon tamponade has become the preferred initial approach. We report our experience and review the technique. Eleven patients underwent primary treatment with balloon tamponade from 2001 to 2012. Using either femoral or brachial approach, an appropriately sized balloon was placed directly adjacent to the site of hemorrhage and inflated for 5-25 min on the basis of operator preference and repeated as needed. Primary technical success defined as hemostasis was achieved with balloon tamponade. Technical success was achieved in nine of 11 patients. The mean follow-up time was 10.8 months. Two deaths were reported, both unrelated to catheter placement and removal. Of the successful cases, five achieved hemostasis with one inflation and four required two inflations. One patient developed a small thrombus at the thyrocervical trunk of no clinical significance. No other complications occurred. One of the nine patients had a double wall injury. The two patients with unsuccessful hemostasis underwent two & four inflations, respectively. Both patients had a double wall injury. One of the patients had a complication of distal ischemia and stroke. In patients with inadvertent subclavian artery catheterization, balloon tamponade is an effective first step in management, with primary technical success approaching 100% in cases of single lumen injury. It appears less effective in patients with double lumen injury. However, the ease of transition from balloon tamponade to stent placement supports an initial attempt at hemostasis with tamponade prior to placement of a permanent stent.

Radiographic mislead: apparent arterial placement of subclavian central venous catheter due to mediastinal shift

Optimal placement of central venous catheters (CVC) is essential for accurate monitoring of central venous pressure (CVP) in major surgeries and ensuring long-term use of the catheter for managing the critically ill patient. Accidental subclavian artery catheterization is one of the most serious complications of the procedure. Radiography is commonly used to ensure optimal placement of CVC tip and rule out subclavian artery catheterization in the absence of Doppler ultrasound and a pressure transducer. We present a case of a haemodynamically unstable and hypoxaemic patient with mediastinal shift, in which the anaesthesiologist was in a dilemma about the arterial placement of the right subclavian CVC. The CVC crossing the midline due to mediastinal shift gave the false impression of it being placed in subclavian artery rather than the vein. Subsequently, it was proved to be correctly placed in the subclavian vein.

Percutaneous Suture-Based Closure Device for Management of Inadvertent Subclavian Artery Catheterization

Central venous catheterization is performed to secure pathways for large amounts of saline, drug infusion, parenteral nutrition support, and hemodialysis. Accidental subclavian artery cannulation is a possible complication of central venous catheterization. Here, we report two cases of 8 Fr. chemoports inadvertently inserted in subclavian arteries during internal jugular venous catheterizations. The chemoports were removed successfully, and puncture sites were repaired using suture-based closure devices (Perclose). One patient experienced minor neurological complications after the procedure. With effective management, the patient was treated with no sequelae. To our knowledge, this is the first report of stroke after procedures using suture-based devices. (Korean J Med 2014;87:200-204)

Transcutaneous aortic valve implantation using the axillary/subclavian access with patent left internal thoracic artery to left anterior descending artery: Feasibility and early clinical outcomes

Both retrograde femoral and subclavian artery catheterization techniques have been described as the most common methods for the implantation of the Medtronic CoreValve percutaneous aortic valve (Medtronic Inc, Minneapolis, Minn). The subclavian artery has been shown to be a safe and effective alternative access route in patients with unfavorable femoral access. Of the patients who are identified as candidates for subclavian artery access, a subset possess a patent left internal thoracic artery to left anterior descending artery. This patent left internal thoracic artery presents an additional anatomic and clinical variable that must be taken into consideration to ensure procedural safety and efficacy. We describe the Medtronic CoreValve percutaneous aortic valve implantation using the subclavian arterial approach in patients with a patent left internal thoracic artery and report our study's findings. The CoreValve percutaneous aortic valve is a self-expandable nitinol-based frame with a porcine pericardial valve. The subclavian access was created by a small infraclavicular surgical incision to expose the artery. Rapid ventricular pacing was used to reduce cardiac output to perform the balloon aortic valvuloplasty via a 12F sheath inserted into the subclavian artery. An 18F sheath was then inserted into the artery down into the ascending aorta and used for introduction of the delivery catheter and implantation of the percutaneous aortic valve. With the use of this method, 19 patients (76 ± 13 years) whose surgical risk was deemed excessive because of severe comorbidity and in whom transfemoral catheterization was considered unfeasible or at risk of severe complications have received implants. Subclavian artery or left internal thoracic artery injury did not occur in any patient. Two deaths occurred. One patient died of right coronary artery occlusion during the procedure, and one patient died 48 hours after the procedure as the result of a tamponade after the temporary pacemaker wire ablation. This initial experience suggests that subclavian transarterial aortic valve implantation in patients with a patent left internal thoracic artery to left anterior descending artery is feasible and safe with satisfactory short-term outcomes.

Arterial Injury Complicating Subclavian Central Venous Catheter Insertion

n i a a g n c INADEQUATE PLACEMENT of a subclavian venous catheter in the subclavian artery is a well-known complication.1,2 Three cases of accidental arterial puncture occurred with the implantation of subclavian venous catheters, 2 of which involved the subclavian artery leading to percutaneous treatment; and the other involved the aortic arch, resulting in surgical management, are described.

Endovascular Management of Inadvertent Subclavian Artery Catheterization during Subclavian Vein Cannulation

To retrospectively review a 9-year experience with endovascular management of inadvertent subclavian artery catheterization during subclavian vein cannulation. From June 2000 through July 2009 (109 months), 13 patients underwent endovascular management of inadvertent subclavian artery catheterization. All catheters were still in situ, including one 7-F catheter, six 8-F catheters, and six large-bore 10-11-F catheters. Treatment was performed with an Angio-Seal device (n = 6) or balloon catheters (n = 7) and by additional stent-graft placement (n = 4). Mean follow-up was 27.3 months (range, 0.4-78 months). The 30-day mortality rate was 7.7% and the late mortality rate was 46.1%. Primary technical success was achieved in nine patients (69.2%), in four with the use of a compliant balloon catheter and in the other five with an Angio-Seal device. Complications required additional stent-graft placement in four patients (30.8%), one because of stenosis after Angio-Seal device deployment and three as a result of insufficient closure of the puncture site by balloon tamponade. Stent-graft repair was successful in all four patients, for a primary assisted technical success rate of 100%. Endovascular techniques offer a less invasive alternative to surgery. The present limited experience shows that the use of the Angio-Seal device is not without risks, whereas balloon tamponade is not always reliable in closing the puncture site. Stent-graft placement may be required in patients in whom balloon tamponade fails or in whom the use of the Angio-Seal device is contraindicated.

Experience and Technique for the Endovascular Management of Iatrogenic Subclavian Artery Injury

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. 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. 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. This minimally invasive endovascular approach to iatrogenic subclavian artery injury is a safe alternative to blind removal with manual compression or direct open repair.

Inadvertent subclavian artery catheter placement complicated by stroke: Endovascular management and review

Removal of large-bore venous catheters misplaced within the subclavian artery risks significant hemorrhage due to the noncompressible entry site. Comorbidities in these patients often make traditional surgical approaches prohibitive. We present a case of inadvertent subclavian artery placement of a central venous catheter complicated by thromboembolic stroke, illustrate treatment with a combination of percutaneous closure and temporary balloon tamponade, and review the endovascular management of this unusual problem. Endovascular treatment of inadvertent subclavian artery catheterization appears to be a reasonable option, and its less-invasive nature may be beneficial for patients in whom the underlying disease initially required central venous access.

Poland syndrome: A contraindication to the use of the internal thoracic artery in coronary artery bypass grafting?

Poland syndrome (PS) is a rare congenital disorder that is present in 1:30,000 people. It is primarily characterized by hypoplasia of the pectoralis muscles, with associated ipsilateral syndactyly of the upper extremity. Although the true cause of PS remains unknown, the prevailing theory attributes these sequelae to hypoplasia of the subclavian artery or its branches as the result of an in utero vascular accident. 1,2 Contemplating how to perform coronary artery bypass grafting (CABG) in a patient with left-sided PS is therefore of particular interest, because hypoplasia of the subclavian artery would theoretically render the left internal thoracic artery (LITA) inadequate for use. Consistent with yet exacerbating this clinical conundrum, no cases of CABG in patients with PS have previously been reported. We recently encountered a patient with undiagnosed left-sided PS with significant coronary artery disease involving the left anterior descending coronary artery. Our preoperative workup included diagnostic imaging of the heart and great vessels to assess the adequacy of the LITA as a bypass conduit. Surprisingly, our evaluation demonstrated normal left subclavian artery and LITA anatomy, thus calling into question the currently accepted theory for this unusual syndrome. Clinical Summary A 70-year-old man was seen with anginal symptoms that had worsened during the previous 2 weeks. Physical examination revealed syndactyly of the left hand and hypoplasia of the left breast (Figure 1). Cardiac catheterization demonstrated three-vessel coronary artery disease, including a severely occluded left anterior descending coronary artery. After surgical consultation, the presence of the aforementioned phenotype was noted, and select subclavian artery catheterization was therefore performed. Interestingly, a widely patent subclavian artery and LITA were seen. Because of the possibility of chest wall deformity that might alter our sternotomy and closure, a computed tomographic angiographic study was also performed (Figure 2). This scan confirmed the absence of pectoralis musculature and demonstrated a normal bony thoracic cage. Moreover, normal caliber subclavian artery and LITA were confirmed. Intraoperative assessment of the LITA also revealed a normal artery with adequate flow by visual inspection. Four-vessel CABG was therefore performed, which included a LITA conduit to the left anterior descending coronary artery. The remainder of the operative and postoperative course was unremarkable.

Percutaneous Closure of a Subclavian Artery Injury after Inadvertent Catheterization

Life-threatening complications of subclavian central venous access are rare. Herein a case of inadvertent subclavian artery catheterization and subsequent percutaneous arterial repair with use of the Prostar XL suture-mediated closure device and temporary balloon tamponade is reported. This approach obviated a complex surgical intervention that would have required medial clavicle resection.

Subclavian artery catheterization: A new approach for endovascular procedures

Purpose: Percutaneous access to the arterial system for endovascular procedures is usually achieved through the femoral arteries. When femoral access is precluded, the axillary or brachial arteries serve as alternatives. Complications associated with the use of the latter arteries have led us to develop subclavian arterial catheterization.Methods and Results: From 1978 to 1993, 569 patients underwent angiography via the subclavian artery (> 99% left subclavian artery); 134 were studies of the aortic arch and brachiocephalic vessels; 435 studies involved the descending and abdominal aorta and its branches and runoff. Coronary arteriography was also feasible. Since 1986, 44 patients have undergone endovascular procedures: 33 percutaneous transluminal angioplasties of the visceral, iliac, femoral, and popliteal arteries and 11 thrombolytic procedures of aortofemoral graft limbs (n = 3) and femoral distal bypasses (n = 8) were performed. Complications (1.2%) included partial pneumothorax (n = 2), hemorrhage requiring operative control (n = 2), causalgia (n = 1) and embolization (n = 2).Conclusions: Whenever percutaneous femoral catheterization cannot be achieved or an alternate access point is indicated, we select the subclavian approach as an alternative to axillary, brachial or translumbar access. It is safe, expeditious, and versatile for virtually all types of systemic and cardiac catheterization; it is also applicable to thrombolysis and balloon angioplasty.

Direct Percutaneous Infraclavicular Catheterization of Subclavian Artery

Direct Percutaneous Infraclavicular Catheterization of Subclavian Artery