Related Experiment Video
Updated: Jan 19, 2026
Catheter Insertion in Internal Jugular: the Seldinger Technique
Published on: April 30, 2023
Covered Stenting as Bail-Out Technique for Central Venous Catheter Malposition Within the Brachiocephalic Trunk
Joseph Faraj1, Anwar Choudhary1, Jens C Ritter1,2
1Department of Vascular Surgery, Fiona Stanley Hospital, Perth, Western Australia, Australia.
Insights
Ultrasound-guided central venous catheter insertion is common. A novel technique successfully removed a catheter misplaced into the brachiocephalic trunk, preventing serious arterial complications.
Area of Science:
- Vascular Surgery
- Interventional Radiology
- Critical Care Medicine
Background:
- Central venous catheter (CVC) insertion is a standard procedure in critical care.
- Ultrasound guidance minimizes, but does not eliminate, risks like arterial malposition.
- Arterial malposition of CVCs can lead to life-threatening hemorrhage, stroke, or death.
Observation:
- A case involving a right-sided CVC mispositioned into the brachiocephalic trunk (BCT) at the origin of the right common carotid artery (CCA) is presented.
- This malposition posed a significant risk of major vascular injury and neurological complications.
Findings:
- A "bail-out" technique was successfully employed for the removal of the misplaced CVC.
- The technique involved covered stenting of the BCT extending into the CCA.
- Simultaneously, plug embolization of the right subclavian artery was performed.
Implications:
- This described technique offers a viable solution for managing CVC arterial malposition in the BCT/CCA region.
- Successful intervention can prevent catastrophic vascular and neurological complications.
- Highlights the importance of advanced endovascular techniques in critical care settings.
Abstract:
Central venous catheter (CVC) insertion with ultrasound guidance is routine clinical practice in the critically ill patient. Arterial malposition is serious and may lead to severe complications such as hemorrhage, stroke, or death. We describe a bail-out technique for removal of right-sided CVC that was mispositioned into the brachiocephalic trunk (BCT) at the origin of the right common carotid artery (CCA). Covered stenting of the BCT extending into the CCA in combination with plug embolization of the right subclavian artery was utilized.
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