title: Internal mammary artery injury during central venous catheter insertion for TPN: rare but fatal.
abstract: Vascular injuries caused by subclavian central venous catheter (CVC) insertion can be associated with major complications. Such injuries differ in clinical presentation as well as optimal management, which ranges from observation only to surgical or endovascular repair. We report an injury to a branch of the internal mammary artery following an attempt to introduce a subclavian CVC, resulting in a massive hemothorax. This very rare injury was diagnosed and treated by angiography and embolization; however, the patient later succumbed to multi-organ failure. Suspicion of such an injury in a similar clinical setting should result in immediate angiography that can be lifesaving. To the best of our knowledge, this is the only report of such an adverse event in an adult.
authors.affiliation: Department of Surgery, Hadassah-Hebrew University Medical Center & Hebrew University-Hadassah Medical School, Jerusalem, Israel. haggi.mazeh@gmail.com
authors.forename: Haggi
authors.initials: H
authors.lastname: Mazeh
authors.forename: Bilal
authors.initials: B
authors.lastname: Alaiyan
authors.forename: Ori
authors.initials: O
authors.lastname: Wald
authors.forename: Ido
authors.initials: I
authors.lastname: Mizrahi
authors.forename: Alexander
authors.initials: A
authors.lastname: Klimov
authors.forename: Ahmed
authors.initials: A
authors.lastname: Eid
authors.forename: Herbert R
authors.initials: HR
authors.lastname: Freund
mesh_terms: D002405:Catheterization, Central Venous / Q000009:adverse effects*; D057210:Delayed Diagnosis; D004621:Embolization, Therapeutic; D017809:Fatal Outcome; D005260:Female; D006491:Hemothorax / Q000000981:diagnostic imaging / Q000209:etiology* / Q000628:therapy; D006801:Humans; D008323:Mammary Arteries / Q000000981:diagnostic imaging / Q000293:injuries*; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000209:etiology*; D010289:Parenteral Nutrition, Total; D011859:Radiography; D013350:Subclavian Vein