title: Experience and technique for the endovascular management of iatrogenic subclavian artery injury.
abstract: BACKGROUND
  Inadvertent subclavian artery catheterization during attempted central venous access is a well-known complication. Historically, these patients are managed with an open operative approach and repair under direct vision via an infraclavicular and/or supraclavicular incision. We describe our experience and technique for endovascular management of these injuries.
  
  
  METHODS
  Twenty patients were identified with inadvertent iatrogenic subclavian artery cannulation. All cases were managed via an endovascular technique under local anesthesia. After correcting any coagulopathy, a 4-French glide catheter was percutaneously inserted into the ipsilateral brachial artery and placed in the proximal subclavian artery. Following an arteriogram and localization of the subclavian arterial insertion site, the subclavian catheter was removed and bimanual compression was performed on both sides of the clavicle around the puncture site for 20 min. A second angiogram was performed, and if there was any extravasation, pressure was held for an additional 20 min. If hemostasis was still not obtained, a stent graft was placed via the brachial access site to repair the arterial defect and control the bleeding.
  
  
  RESULTS
  Two of the 20 patients required a stent graft for continued bleeding after compression. Both patients were well excluded after endovascular graft placement. Hemostasis was successfully obtained with bimanual compression over the puncture site in the remaining 18 patients. There were no resultant complications at either the subclavian or the brachial puncture site.
  
  
  CONCLUSIONS
  This minimally invasive endovascular approach to iatrogenic subclavian artery injury is a safe alternative to blind removal with manual compression or direct open repair.
authors.affiliation: Division of Vascular Surgery, New York University Medical Center, 530 1st Avenue, Suite 6F, New York, NY 10016, USA. neal.cayne@nyumc.org
authors.forename: N S
authors.initials: NS
authors.lastname: Cayne
authors.forename: T L
authors.initials: TL
authors.lastname: Berland
authors.forename: C B
authors.initials: CB
authors.lastname: Rockman
authors.forename: T S
authors.initials: TS
authors.lastname: Maldonado
authors.forename: M A
authors.initials: MA
authors.lastname: Adelman
authors.forename: G R
authors.initials: GR
authors.lastname: Jacobowitz
authors.forename: P J
authors.initials: PJ
authors.lastname: Lamparello
authors.forename: F
authors.initials: F
authors.lastname: Mussa
authors.forename: S
authors.initials: S
authors.lastname: Bauer
authors.forename: S S
authors.initials: SS
authors.lastname: Saltzberg
authors.forename: F J
authors.initials: FJ
authors.lastname: Veith
mesh_terms: D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000295:instrumentation; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D006470:Hemorrhage / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D006489:Hemostatic Techniques / Q000295:instrumentation; D006801:Humans; D007049:Iatrogenic Disease; D011312:Pressure; D011859:Radiography; D012189:Retrospective Studies; D015607:Stents; D013348:Subclavian Artery / Q000000981:diagnostic imaging / Q000293:injuries*; D013997:Time Factors; D016896:Treatment Outcome; D014950:Wounds, Penetrating / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*