Managing inadvertent arterial catheterization during central venous access procedures.
OBJECTIVE
Approximately 200,000 central venous catheterizations are carried out annually in the National Health Service in the United Kingdom. Inadvertent arterial puncture occurs in up to 3.7%. Significant morbidity and death has been reported. We report on our experience in the endovascular treatment of this iatrogenic complication.


METHODS
Retrospective analysis was carried out of 9 cases referred for endovascular treatment of inadvertent arterial puncture during central venous catheterization over a 5 year period.


RESULTS
It was not possible to obtain accurate figures on the numbers of central venous catheterizations carried out during the time period. Five patients were referred with carotid or subclavian pseudoaneurysms and hemothorax following inadvertent arterial catheter insertion and subsequent removal. These patients all underwent percutaneous balloon tamponade and/or stent-graft insertion. More recently 4 patients were referred with the catheter still in situ and were successfully treated with a percutaneous closure device.


CONCLUSIONS
If inadvertent arterial catheterization during central venous access procedures is recognized and catheters removed, sequelae can be treated percutaneously. However, once the complication is recognized it is better to leave the catheter in situ and seal the artery percutaneously with a closure device.
Nicholson
Tony
T
Department of Vascular Radiology, Hull and East Yorkshire Hospitals Trust, Anlaby Road, Hull HU3 2JZ, UK. Tony.Nicholson@leedsth.nhs.uk
Ettles
Duncan
D
Robinson
Graham
G
D000328:Adult; D000368:Aged; D019917:Blood Vessel Prosthesis Implantation; D001916:Brachial Artery / Q000601:surgery; D017536:Carotid Artery, Common / Q000601:surgery; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D005260:Female; D005263:Femoral Artery / Q000601:surgery; D005500:Follow-Up Studies; D005548:Foreign-Body Migration / Q000209:etiology* / Q000401:mortality / Q000601:surgery*; D006801:Humans; D007431:Intraoperative Complications / Q000209:etiology* / Q000401:mortality / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015607:Stents; D013348:Subclavian Artery / Q000601:surgery; D016019:Survival Analysis; D016896:Treatment Outcome; D006113:United Kingdom; D014711:Vertebral Artery / Q000601:surgery