Arterial Closure Devices for Treatment of Inadvertent Large-Caliber Catheter Insertion Into the Subclavian or Carotid Artery: A Case Series of Five Patients

CENTRAL VENOUS CATHETERIZATION is a common procedure in today`s medicine. Iatrogenic complications occur in up to 34% of catheter placements including 5% of arterial puncture. A variety of complications by arterial puncture have recently been described, including airway obstruction, pseudoaneurysms, arteriovenous fistulas, and even stroke caused by arterial thrombosis or embolization. Although 2-D ultrasound assisted insertion of large central venous catheters may reduce adverse events, it might not be available in an emergency setting, and the use of ultrasound guidance requires training. Depending on anatomic localization and diameter of the catheters and the condition of the patient, treatment options range from extraction and conservative measures to open treatment with sternotomy. Complication and mortality rates of up to 47% and 12%, respectively, are reported for blind extraction of the devices. Open surgical treatment and general anesthesia may be associated with elevated risk in medically frail patients. Endovascular treatment options in artery trauma described in the literature range from catheter-guided compression to insertion of stent grafts and the use of percutaneous closure devices. The authors report their own experiences with 5 patients being treated with 2 different arterial closure devices for inadvertent insertion of large caliber catheters into either the subclavian or carotid artery.
Source: Journal of Cardiothoracic and Vascular Anesthesia - Category: Anesthesiology Authors: Tags: Case Reports Source Type: research