Misplaced central line piercing common carotid removed and stented through a multidisciplinary approach: A video...

Area of Science:

• Vascular Surgery
• Interventional Radiology
• Critical Care Medicine

Background:

• Central venous catheterizations are vital in critical care but carry a 3% risk of major complications.
• Inadvertent carotid artery injury during central line placement is rare (0.1%-0.5%) but potentially life-threatening.
• Iatrogenic vascular events require timely and effective management, especially in high-risk patients.

Purpose of the Study:

• To present a case of successful endovascular management of a central venous line inadvertently placed into the common carotid artery and left ventricle.
• To highlight the utility of stent grafts in treating iatrogenic arterial injuries.
• To emphasize the consideration of minimally invasive techniques in complex vascular repairs.

Main Methods:

• A 54-year-old female with septic shock experienced central line misplacement, piercing the left common carotid artery and extending into the left ventricle.
• A multidisciplinary team opted for endovascular repair due to high surgical risk.
• The patient underwent successful stenting of the left common carotid artery with a covered stent graft and simultaneous central line removal in a hybrid interventional suite.

Main Results:

• The endovascular procedure was technically successful, with excellent flow through the carotid stent grafts.
• Post-procedure and three-month follow-up imaging confirmed the patency of the repaired artery.
• The patient tolerated the procedure well, avoiding high-risk open surgery.

Conclusions:

• Endovascular management with stent grafts is a viable and effective option for iatrogenic carotid artery injuries.
• Minimally invasive techniques should be considered for vascular repair when surgical access is challenging or patient risk is high.
• This case underscores the importance of advanced interventional techniques in managing critical vascular complications.