Endovascular treatment of inadvertent cannulation of the vertebro-subclavian arterial junction.
BACKGROUND
Inadvertent arterial cannulation at a noncompressible site is a highly risky complication of central venous line placement.


METHODS
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.
Wolfe
Thomas J
TJ
Department of Neurology, Medical College of Wisconsin/Froedtert Hospital, 9200 W. Wisconsin Avenue, Milwaukee, WI 53226, USA.
Smith
Tony P
TP
Alexander
Michael J
MJ
Zaidat
Osama O
OO
D000328:Adult; D017130:Angioplasty; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D004621:Embolization, Therapeutic / Q000379:methods*; D006801:Humans; D008297:Male; D019300:Medical Errors / Q000009:adverse effects*; D015607:Stents; D013348:Subclavian Artery / Q000293:injuries*; D014711:Vertebral Artery; D014950:Wounds, Penetrating / Q000209:etiology / Q000628:therapy*