Subclavian artery puncture repair with Angio-Seal deployment.
BACKGROUND
Inadvertent placement of a port-a-catheter in an artery during central venous cannulation is rare and can result in devastating complications. Although traditional closure devices have been employed as prompt and adequate treatment, more innovative devices such as collagen plugs are being studied for their efficacy.


METHODS
We report a case involving a 63-year-old woman who was treated with chemotherapy for recurrent metastatic uterine leiomyosarcoma. During port-a-catheter placement, puncture of the subclavian artery occurred. Vascular surgery and interventional radiology consultation was obtained, wherein an Angio-Seal device was used to seal the exit from the subclavian artery. Angio-Seal placement was successful and the patient has since become clinically stable and was then discharged.


CONCLUSIONS
Subclavian artery puncture is rare but can occur due to the close proximity between the subclavian artery and vein. Prompt vascular surgery and radiology consultation is necessary. Although traditional manual compression and closure devices have been effective at restoring hemostasis, collagen seals or plugs may be more viable to treat this precarious situation.
Micha
John P
JP
Gynecologic Oncology Associates, Hoag Cancer Center, 351 Hospital Road, Suite 507, Newport Beach, CA 92663, USA. bram@gynoncology.com
Goldstein
Bram H
BH
Lindsay
Stephen F
SF
Haskell
Richard
R
Oglevie
Steven
S
Rettenmaier
Mark A
MA
Brown
John V
JV
D002405:Catheterization, Central Venous / Q000009:adverse effects*; D002408:Catheters, Indwelling / Q000009:adverse effects*; D005260:Female; D006489:Hemostatic Techniques; D006801:Humans; D007890:Leiomyosarcoma / Q000188:drug therapy; D008875:Middle Aged; D011677:Punctures; D013348:Subclavian Artery / Q000293:injuries*; D014594:Uterine Neoplasms / Q000188:drug therapy