Balloon tamponade repair after inadvertent subclavian artery catheterization

The approach to repair inadvertent subclavian artery catheterization has evolved to increasingly less invasive modalities. Most recently, endovascular balloon tamponade has become the preferred initial approach. We report our experience and review the technique.

Eleven patients underwent primary treatment with balloon tamponade from 2001 to 2012. Using either femoral or brachial approach, an appropriately sized balloon was placed directly adjacent to the site of hemorrhage and inflated for 5-25 min on the basis of operator preference and repeated as needed. Primary technical success defined as hemostasis was achieved with balloon tamponade.

Technical success was achieved in nine of 11 patients. The mean follow-up time was 10.8 months. Two deaths were reported, both unrelated to catheter placement and removal. Of the successful cases, five achieved hemostasis with one inflation and four required two inflations. One patient developed a small thrombus at the thyrocervical trunk of no clinical significance. No other complications occurred. One of the nine patients had a double wall injury. The two patients with unsuccessful hemostasis underwent two & four inflations, respectively. Both patients had a double wall injury. One of the patients had a complication of distal ischemia and stroke.

In patients with inadvertent subclavian artery catheterization, balloon tamponade is an effective first step in management, with primary technical success approaching 100% in cases of single lumen injury. It appears less effective in patients with double lumen injury. However, the ease of transition from balloon tamponade to stent placement supports an initial attempt at hemostasis with tamponade prior to placement of a permanent stent.