Iatrogenic vertebral artery injury during central line placement: a case report

Central venous catheterization is commonly performed in critically ill patients but carries risks, including arterial injury. Vertebral artery injury during central venous catheterization insertion is rare but can cause severe morbidity and mortality if not promptly recognized and managed. Early diagnosis and intervention are crucial to minimizing complications. A 55-year-old Arab male of Middle Eastern ethnicity with severe community-acquired pneumonia required intubation and vasopressor support. During an attempt to insert a central venous catheterization through the left internal jugular vein, the patient developed acute hypotension and a significant hemoglobin drop, indicating active bleeding. Computed tomography angiography confirmed a left vertebral artery injury. Endovascular repair with a covered balloon-expandable stent via brachial access led to immediate hemodynamic stabilization and bleeding control. This case highlights the importance of meticulous technique, monitoring, and advanced imaging. Vascular surgery consultation and imaging guide management. Endovascular procedures offer safer, less invasive options when performed by experienced interventionists.