Inadvertent Arterial Placement of Central Venous Catheters: Systematic Review and Guidelines for Treatment

Area of Science:

• Vascular Surgery
• Interventional Radiology

Background:

• Inadvertent arterial placement of central venous catheters (CVCs) can lead to severe complications such as pseudoaneurysm and stroke.
• Current therapeutic strategies for managing arterial injury from CVC placement lack a definitive standard of care.

Purpose of the Study:

• To systematically review treatment outcomes for arterial injuries resulting from CVC placement.
• To compare the efficacy of different repair methods for inadvertent arterial catheterization.

Main Methods:

• A systematic review of articles published between January 2000 and July 2018.
• Included studies focused on CVC placement in the brachiocephalic/subclavian arteries, carotid artery, vertebral artery, and aortic arch.
• Analyzed treatments including manual pressure, endovascular techniques (balloon tamponade, closure devices, stent grafts), and open surgery.

Main Results:

• Endovascular techniques and open surgery demonstrated higher success rates in arterial repair compared to manual compression.
• Specific endovascular methods like balloon tamponade, percutaneous closure devices, and covered stent placement were evaluated.
• The review identified varying success rates across different repair modalities.

Conclusions:

• Endovascular interventions and surgical repair represent more effective strategies for managing arterial injuries caused by CVC placement.
• Further research may be needed to establish a definitive standard of care, but current evidence favors advanced techniques.
• Optimal management of inadvertent arterial CVC placement relies on timely and appropriate intervention, with endovascular and surgical approaches showing promise.