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Endovascular management of inadvertent subclavian artery catheterization during subclavian vein cannulation
Andreas P Chemelli1, Franz Wiedermann, Josef Klocker
1Department of Radiology, Innsbruck Medical University, 6020 Innsbruck, Austria.
Insights
Endovascular management of accidental subclavian artery catheterization is feasible. While Angio-Seal devices carry risks and balloon tamponade can be unreliable, stent-graft placement offers a successful alternative.
Area of Science:
- Vascular Surgery
- Interventional Radiology
- Endovascular Techniques
Background:
- Subclavian vein cannulation is a common procedure.
- Inadvertent subclavian artery catheterization is a rare but serious complication.
- Prompt management is crucial to prevent significant morbidity and mortality.
Purpose of the Study:
- To review the 9-year experience with endovascular management of inadvertent subclavian artery catheterization.
- To evaluate the efficacy and safety of different endovascular techniques.
- To identify factors influencing treatment success and complications.
Main Methods:
- Retrospective review of 13 patients from June 2000 to July 2009.
- Endovascular treatment using Angio-Seal device or balloon catheters.
- Additional stent-graft placement in complicated cases.
Main Results:
- Primary technical success achieved in 69.2% of patients.
- Complications included stenosis and inadequate puncture site closure.
- Stent-graft placement was required in 30.8% of patients, achieving 100% success.
- 30-day mortality rate was 7.7%.
Conclusions:
- Endovascular management is a less invasive alternative to surgery for inadvertent subclavian artery catheterization.
- Angio-Seal device use is associated with risks.
- Balloon tamponade may not always achieve sufficient hemostasis.
- Stent-graft placement is a reliable option for managing treatment failures or contraindications.
Purpose:
To retrospectively review a 9-year experience with endovascular management of inadvertent subclavian artery catheterization during subclavian vein cannulation.
Materials And Methods:
From June 2000 through July 2009 (109 months), 13 patients underwent endovascular management of inadvertent subclavian artery catheterization. All catheters were still in situ, including one 7-F catheter, six 8-F catheters, and six large-bore 10-11-F catheters. Treatment was performed with an Angio-Seal device (n = 6) or balloon catheters (n = 7) and by additional stent-graft placement (n = 4).
Results:
Mean follow-up was 27.3 months (range, 0.4-78 months). The 30-day mortality rate was 7.7% and the late mortality rate was 46.1%. Primary technical success was achieved in nine patients (69.2%), in four with the use of a compliant balloon catheter and in the other five with an Angio-Seal device. Complications required additional stent-graft placement in four patients (30.8%), one because of stenosis after Angio-Seal device deployment and three as a result of insufficient closure of the puncture site by balloon tamponade. Stent-graft repair was successful in all four patients, for a primary assisted technical success rate of 100%.
Conclusions:
Endovascular techniques offer a less invasive alternative to surgery. The present limited experience shows that the use of the Angio-Seal device is not without risks, whereas balloon tamponade is not always reliable in closing the puncture site. Stent-graft placement may be required in patients in whom balloon tamponade fails or in whom the use of the Angio-Seal device is contraindicated.
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