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Experience and technique for the endovascular management of iatrogenic subclavian artery injury.
Ann Vasc Surg 2010; 24(1):44-7AV

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.

CONCLUSION

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+Show Affiliations

Division of Vascular Surgery, New York University Medical Center, 530 1st Avenue, Suite 6F, New York, NY 10016, USA. neal.cayne@nyumc.orgNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

19734007

Citation

Cayne, N S., et al. "Experience and Technique for the Endovascular Management of Iatrogenic Subclavian Artery Injury." Annals of Vascular Surgery, vol. 24, no. 1, 2010, pp. 44-7.
Cayne NS, Berland TL, Rockman CB, et al. Experience and technique for the endovascular management of iatrogenic subclavian artery injury. Ann Vasc Surg. 2010;24(1):44-7.
Cayne, N. S., Berland, T. L., Rockman, C. B., Maldonado, T. S., Adelman, M. A., Jacobowitz, G. R., ... Veith, F. J. (2010). Experience and technique for the endovascular management of iatrogenic subclavian artery injury. Annals of Vascular Surgery, 24(1), pp. 44-7. doi:10.1016/j.avsg.2009.06.017.
Cayne NS, et al. Experience and Technique for the Endovascular Management of Iatrogenic Subclavian Artery Injury. Ann Vasc Surg. 2010;24(1):44-7. PubMed PMID: 19734007.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Experience and technique for the endovascular management of iatrogenic subclavian artery injury. AU - Cayne,N S, AU - Berland,T L, AU - Rockman,C B, AU - Maldonado,T S, AU - Adelman,M A, AU - Jacobowitz,G R, AU - Lamparello,P J, AU - Mussa,F, AU - Bauer,S, AU - Saltzberg,S S, AU - Veith,F J, Y1 - 2009/09/05/ PY - 2009/02/17/received PY - 2009/05/30/revised PY - 2009/06/23/accepted PY - 2009/9/8/entrez PY - 2009/9/8/pubmed PY - 2010/4/29/medline SP - 44 EP - 7 JF - Annals of vascular surgery JO - Ann Vasc Surg VL - 24 IS - 1 N2 - 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. CONCLUSION: This minimally invasive endovascular approach to iatrogenic subclavian artery injury is a safe alternative to blind removal with manual compression or direct open repair. SN - 1615-5947 UR - https://www.unboundmedicine.com/medline/citation/19734007/Experience_and_technique_for_the_endovascular_management_of_iatrogenic_subclavian_artery_injury_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0890-5096(09)00152-6 DB - PRIME DP - Unbound Medicine ER -