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Endovascular management of inadvertent brachiocephalic arterial catheterization.
J Neurosurg 2011; 114(1):146-52JN

Abstract

OBJECT

Inadvertent catheterization of brachiocephalic arteries (carotid artery, subclavian artery, or vertebral artery) during attempted placement of a central venous catheter can have potentially disastrous complications. While removal of the catheter in the operating room is almost always an option, there are circumstances in which a less invasive approach may be more appropriate. The authors present their experience using endovascular techniques for removal of inadvertently placed central venous catheters to elucidate potential options for successful nonsurgical management.

METHODS

The authors reviewed their database of interventional procedures that occurred between January 1, 2000, and February 1, 2009. All cases referred for management of suspected brachiocephalic arterial catheterization or arterial injury after attempted placement of a central venous catheter were included. Medical records and radiological imaging were reviewed to determine patient demographics, clinical situation, methods for removal, as well as clinical and imaging follow-up.

RESULTS

A total of 13 patients, ranging in age from 31 to 88 years old, were referred to interventional radiology for management of suspected inadvertent arterial catheterization of the brachiocephalic arteries. Angiography confirmed arterial catheterization in 9 patients. Three patients were referred after developing uncontrolled hemorrhage or expanding hematomas following attempted catheterization. One patient who had an arterial waveform after placement of an internal jugular catheter was found to have early venous filling from a dialysis fistula requiring no intervention. Ten patients were treated in the interventional suite using angiographically monitored manual pressure (1 patient), balloon tamponade (3 patients), use of a percutaneous closure device (1 patient), stent grafting (4 patients), or embolization of the injured vessel alone (1 patient). One patient was taken to the operating room for removal of the inadvertently placed catheter due to vessel thrombosis. No procedural complications were encountered, and no patient required sacrifice of a major brachiocephalic vessel.

CONCLUSIONS

Angiographic evaluation of patients who underwent inadvertent catheterization of brachiocephalic arteries or their branches allowed successful endovascular treatment or excluded the need for intervention in 12 (92%) of 13 patients. The choice and use of specific endovascular techniques should be dictated by patient factors and the vessel inadvertently catheterized.

Authors+Show Affiliations

Division of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

19929193

Citation

Powers, Ciaran J., et al. "Endovascular Management of Inadvertent Brachiocephalic Arterial Catheterization." Journal of Neurosurgery, vol. 114, no. 1, 2011, pp. 146-52.
Powers CJ, Zomorodi AR, Britz GW, et al. Endovascular management of inadvertent brachiocephalic arterial catheterization. J Neurosurg. 2011;114(1):146-52.
Powers, C. J., Zomorodi, A. R., Britz, G. W., Enterline, D. S., Miller, M. J., & Smith, T. P. (2011). Endovascular management of inadvertent brachiocephalic arterial catheterization. Journal of Neurosurgery, 114(1), pp. 146-52. doi:10.3171/2009.10.JNS09940.
Powers CJ, et al. Endovascular Management of Inadvertent Brachiocephalic Arterial Catheterization. J Neurosurg. 2011;114(1):146-52. PubMed PMID: 19929193.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Endovascular management of inadvertent brachiocephalic arterial catheterization. AU - Powers,Ciaran J, AU - Zomorodi,Ali R, AU - Britz,Gavin W, AU - Enterline,David S, AU - Miller,Michael J, AU - Smith,Tony P, Y1 - 2009/11/20/ PY - 2009/11/26/entrez PY - 2009/11/26/pubmed PY - 2011/2/2/medline SP - 146 EP - 52 JF - Journal of neurosurgery JO - J. Neurosurg. VL - 114 IS - 1 N2 - OBJECT: Inadvertent catheterization of brachiocephalic arteries (carotid artery, subclavian artery, or vertebral artery) during attempted placement of a central venous catheter can have potentially disastrous complications. While removal of the catheter in the operating room is almost always an option, there are circumstances in which a less invasive approach may be more appropriate. The authors present their experience using endovascular techniques for removal of inadvertently placed central venous catheters to elucidate potential options for successful nonsurgical management. METHODS: The authors reviewed their database of interventional procedures that occurred between January 1, 2000, and February 1, 2009. All cases referred for management of suspected brachiocephalic arterial catheterization or arterial injury after attempted placement of a central venous catheter were included. Medical records and radiological imaging were reviewed to determine patient demographics, clinical situation, methods for removal, as well as clinical and imaging follow-up. RESULTS: A total of 13 patients, ranging in age from 31 to 88 years old, were referred to interventional radiology for management of suspected inadvertent arterial catheterization of the brachiocephalic arteries. Angiography confirmed arterial catheterization in 9 patients. Three patients were referred after developing uncontrolled hemorrhage or expanding hematomas following attempted catheterization. One patient who had an arterial waveform after placement of an internal jugular catheter was found to have early venous filling from a dialysis fistula requiring no intervention. Ten patients were treated in the interventional suite using angiographically monitored manual pressure (1 patient), balloon tamponade (3 patients), use of a percutaneous closure device (1 patient), stent grafting (4 patients), or embolization of the injured vessel alone (1 patient). One patient was taken to the operating room for removal of the inadvertently placed catheter due to vessel thrombosis. No procedural complications were encountered, and no patient required sacrifice of a major brachiocephalic vessel. CONCLUSIONS: Angiographic evaluation of patients who underwent inadvertent catheterization of brachiocephalic arteries or their branches allowed successful endovascular treatment or excluded the need for intervention in 12 (92%) of 13 patients. The choice and use of specific endovascular techniques should be dictated by patient factors and the vessel inadvertently catheterized. SN - 1933-0693 UR - https://www.unboundmedicine.com/medline/citation/19929193/Endovascular_management_of_inadvertent_brachiocephalic_arterial_catheterization_ L2 - https://thejns.org/doi/10.3171/2009.10.JNS09940 DB - PRIME DP - Unbound Medicine ER -