Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2016 Apr-Jun;26(2):262-6.
doi: 10.4103/0971-3026.184425.

Percutaneous repair of iatrogenic subclavian artery injury by suture-mediated closure device

Rahul S Chivate  1 , Suyash S Kulkarni  1 , Nitin S Shetty  1 , Ashwin M Polnaya  1 , Kunal B Gala  1 , Paresh G Patel  1
Affiliations

Percutaneous repair of iatrogenic subclavian artery injury by suture-mediated closure device

Rahul S Chivate et al. Indian J Radiol Imaging. 2016 Apr-Jun.

Abstract

Central venous catheterization through internal jugular vein is done routinely in intensive care units. It is generally safe, more so when the procedure is performed under ultrasound guidance. However, there could be inadvertent puncture of other vessels in the neck when the procedure is not performed under real-time sonographic guidance. Closure of this vessel opening can pose a challenge if it is an artery, in a location difficult to compress, and is further complicated by deranged coagulation profile. Here, we discuss the removal of an inadvertently placed catheter from subclavian artery with closure of arteriotomy percutaneously using arterial suture-mediated closure device.

Keywords: Inadvertent puncture; percutaneous suture device; subclavian artery.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Computed tomography angiography with coronal reconstructed image shows placement of catheter tip in subclavian artery. Ao - Aorta, C- Catheter
Figure 2
Figure 2
Digital subtraction angiography image of contrast injected through catheter confirms its tip in subclavian artery. C - Catheter, SA - Subclavian artery, VA - Vertebral artery, Ao - Aorta, TC - Thyrocervical trunk, *Left internal mammary artery
Figure 3
Figure 3
Subclavian artery angiography performed using H1 catheter shows subtracted catheter tip between vertebral artery and internal mammary artery. Small suspicious filling defect seen at the puncture site (arrow). SA - Subclavian artery, VA - Vertebral artery, TC - Thyrocervical trunk, LIMA - Left internal mammary artery, H1 - Head hunter catheter H1 4Fr
Figure 4 (A and B)
Figure 4 (A and B)
(A) 6 Fr. Perclose ProGlide Suture Mediated Closure System (Abbott); (B) Radiographic image of device (D) over wire
Figure 5
Figure 5
Perclose device removed and knot tightened with the help of knot tightner. Wire still kept in situ. W - 0.035” Amplatz stiff wire, K - Knot tightner
Figure 6
Figure 6
Subclavian artery angiogram shows no extravasation of contrast. Small filling defect (arrow) seen close to puncture site could be thrombus or dissection flap. SA - Subclavian artery, VA - Vertebral artery, TC - Thyrocervical trunk, LIMA - Left internal mammary artery, K - Knot tightener
Figure 7
Figure 7
Postprocedure reformatted image of computed tomography angiography shows patent left subclavian artery. No thrombus or dissection flap seen. VA - Vertebral artery
See this image and copyright information in PMC

References

    1. Eisen LA, Narasimhan M, Berger JS, Mayo PH, Rosen MJ, Schneider RF. Mechanical complications of central venous catheters. J Intensive Care Med. 2006;21:40–6. - PubMed
    1. Iovino F, Pittiruti M, Buononato M, Lo Schiavo F. Central venous catheterization: Complications of different placements. Ann Chir. 2002;126:1001–6. - PubMed
    1. Szkup PL. A minimally invasive technique for closing an iatrogenic subclavian artery cannulation using the Angio-Seal closure device: Two case reports. J Med Case Rep. 2012;6:82. - PMC - PubMed
    1. Witz M, Yahel J, Lehmann J. Subclavian artery aneurysms. A report of 2 cases and a review of the literature. J Cardiovasc Surg. 1998;39:429–32. - PubMed
    1. Burbridge B, Stoneham G, Szkup P. Percutaneous subclavian artery stent-graft placement following failed ultrasound guided subclavian venous access. BMC Med Imaging. 2007;6:3. - PMC - PubMed