title: Percutaneous arterial closure for inadvertent cannulation of the subclavian artery--a call for caution.
abstract: An uncommon occurrence during central venous catheterization, inadvertent arterial sheath placement can cause potentially serious complications. When the subclavian artery is inadvertently cannulated, catheter removal may be complicated by significant hemorrhage due to its noncompressible location. We report a case of inadvertent insertion of a 7 Fr central venous catheter into the subclavian artery of a patient with severe kyphoscoliosis, Duchenne muscular dystrophy and cardiomyopathy. The catheter was successfully removed, however the initial attempt at closure device deployment resulted in abrupt closure of the subclavian artery. Prompt angiography and balloon inflation via an already present sheath in the brachiocephalic artery resulted in restoration of flow and successful closure at the puncture site with the collagen-based vascular closure device was confirmed. This averted an otherwise urgent surgical sheath removal and arteriotomy repair in an extremely high-risk patient who was deemed a poor candidate for open surgical repair.
authors.affiliation: Department of Medicine, Division of Cardiology, University of California San Francisco, 505 Parnassus Avenue, Box 0124, San Francisco, CA 94143, USA.
authors.forename: Madan
authors.initials: M
authors.lastname: Sharma
authors.forename: Rahul
authors.initials: R
authors.lastname: Sakhuja
authors.forename: David
authors.initials: D
authors.lastname: Teitel
authors.forename: Andrew
authors.initials: A
authors.lastname: Boyle
mesh_terms: D000293:Adolescent; D002404:Catheterization / Q000009:adverse effects*; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D006801:Humans; D008297:Male; D020388:Muscular Dystrophy, Duchenne; D013348:Subclavian Artery / Q000293:injuries* / Q000601:surgery*; D014656:Vascular Surgical Procedures / Q000379:methods*