Percutaneous arterial closure for inadvertent cannulation of the subclavian artery--a call for caution

J Invasive Cardiol. 2008 Jul;20(7):E229-32.

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.

Publication types

  • Case Reports

MeSH terms

  • Adolescent
  • Catheterization / adverse effects*
  • Catheterization, Central Venous / adverse effects*
  • Humans
  • Male
  • Muscular Dystrophy, Duchenne
  • Subclavian Artery / injuries*
  • Subclavian Artery / surgery*
  • Vascular Surgical Procedures / methods*