Neurocritical Care

, Volume 6, Issue 2, pp 113–116

Endovascular treatment of inadvertent cannulation of the vertebro-subclavian arterial junction

  • Thomas J. Wolfe
  • Tony P. Smith
  • Michael J. Alexander
  • Osama O. Zaidat
Practical Pearl

DOI: 10.1007/s12028-007-0016-x

Cite this article as:
Wolfe, T.J., Smith, T.P., Alexander, M.J. et al. Neurocrit Care (2007) 6: 113. doi:10.1007/s12028-007-0016-x

Abstract

Introduction

Inadvertent arterial cannulation at a noncompressible site is a highly risky complication of central venous line placement.

Summary of Case

We present a case of inadvertent placement of a 6-French venous sheath into the right subclavian artery (SCA) at the origin of the vertebral artery (VA), which was treated successfully using endovascular therapy.

Results

Due to the complex site of cannulation, and the patient being fully anticoagulated, the use of a percutaneous closure device was not attempted. Open vascular surgery was not a treatment option due to high surgical risk. After determining left VA dominance, the right VA was occluded distal to the catheter entry point with platinum coils. Subsequently, a covered stent was placed into the SCA across the origin of the VA. The sheath was then removed safely without complications. A minor leak was initially present, which was stopped by repeating balloon inflation within the stent above nominal pressure.

Keywords

Central venous catheter Arterial cannulation Arterial puncture Endovascular Covered stent 

Copyright information

© Humana Press Inc. 2007

Authors and Affiliations

  • Thomas J. Wolfe
    • 1
  • Tony P. Smith
    • 3
  • Michael J. Alexander
    • 4
  • Osama O. Zaidat
    • 1
    • 2
  1. 1.Department of NeurologyMedical College of Wisconsin/Froedtert HospitalMilwaukeeUSA
  2. 2.Department of NeurosurgeryMedical College of Wisconsin/Froedtert HospitalMilwaukeeUSA
  3. 3.Vascular Interventional RadiologyDuke University and Medical CenterDurhamUSA
  4. 4.NeurosurgeryDuke University and Medical CenterDurhamUSA

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