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Life-threatening hemorrhage from inadvertent cervical arteriotomy
Insights
Accidental carotid artery puncture during pulmonary artery catheter insertion can cause severe bleeding. Avoid heparin and delay cardiopulmonary bypass to allow proper healing of these arterial injuries.
Area of Science:
- Cardiovascular Surgery
- Vascular Surgery
- Anesthesiology
Background:
- Pulmonary artery catheters are commonly used in cardiac procedures.
- Preoperative insertion carries risks, including vascular injury.
- Carotid artery access is a potential site for iatrogenic damage.
Observation:
- Two patients undergoing open cardiac surgery experienced catastrophic hemorrhage due to accidental carotid artery puncture during pulmonary artery catheter placement.
- One patient required direct surgical repair of carotid artery lacerations.
- The second patient managed a large extrapleural hematoma conservatively with spontaneous resorption.
Findings:
- Iatrogenic carotid artery injury during pulmonary artery catheterization can lead to significant, life-threatening bleeding.
- Heparinization in patients with such injuries increases bleeding risk.
- Delaying cardiopulmonary bypass is crucial for safe laceration healing.
Implications:
- Clinicians should be vigilant for carotid artery injuries during pulmonary artery catheter insertion.
- Management strategies should include withholding anticoagulation and postponing major procedures.
- Prompt recognition and appropriate management can prevent severe complications from arterial injuries.
Abstract:
Catastrophic hemorrhage followed accidental puncture of the carotid artery or its branches during attempted preoperative insertion of flow-directed balloon-tipped pulmonary artery catheters in 2 patients who underwent open cardiac procedures. Direct repair of two carotid artery lacerations was necessary in 1 patient; the second patient slowly resorbed a large extrapleural hematoma without surgical intervention. This experience suggests that patients experiencing such seemingly innocuous but potentially disastrous arterial injuries should not be heparinized, and that any procedure involving cardiopulmonary bypass should be postponed for several days to allow safe healing of the laceration.