Endovascular Repair Using Suture-Mediated Closure Devices and Balloon Tamponade following Inadvertent Subclavian Artery Catheterization with Large-Caliber Hemodialysis Catheter

Abstract

Accidental subclavian artery cannulation is an uncommon but potentially serious complication of central venous catheterization. Removal of a catheter inadvertently placed in the subclavian artery can lead to substantial bleeding, as achieving hemostasis in this area through manual compression presents considerable difficulty. Additionally, surgical treatment might be unsuitable for high-risk patients due to comorbidities. Here, we report a case of an inadvertently-inserted 11.5-French hemodialysis catheter in the subclavian artery during internal jugular venous catheterization. We performed percutaneous closure of the subclavian artery using three 6-French Perclose Proglide® devices with a balloon tamponade in the proximal part of the subclavian artery. Closure was completed without embolic neurological complications.

Keywords: Central venous catheterization; Complications; Hemodialysis; Vascular closure device.

Fig. 1. Chest X-ray and three-dimensional computed tomography angiography. (A) Chest X-ray showing the misplaced catheter tip in the descending thoracic aorta (DTA, white arrowhead). (B) Curved planar reformatting image of three-dimensional computed tomography angiography of the neck, confirming that the inadvertently inserted catheter penetrated the left internal jugular vein (white arrowhead), entered the left subclavian artery (SCA), and extended into the DTA.

Fig. 2. Temporary balloon tamponade. (A) Angiography showing the catheter's position in the left subclavian artery (SCA) and its insertion site close to the origin of the left vertebral artery (VA, white arrowhead). (B) A 13-mm-diameter occlusion balloon catheter was inflated just distal to the entry site of the misplaced catheter (white arrowhead). (C) Extravasation continued from the entry site of the misplaced catheter, despite more than 1 hour of hemostasis (white arrowhead).

Fig. 3. Endovascular repair using suture-mediated closure devices and a temporary balloon tamponade. (A) A 10-mm-diameter, 20-mm-long, Armada™ 35 percutaneous transluminal angioplasty catheter (Abbott Vascular, Redwood, CA, USA) was inflated within the proximal part of the subclavian artery (white arrowhead). A Perclose Proglide® device (Abbott Vascular, Redwood, CA, USA) was advanced over the guidewire and deployed after removing the guidewire (black asterisk). (B) A 20-mm-diameter occlusion balloon catheter was inflated for longer than 20 minutes just distal to the site of extravasation (white arrowhead). (C) Final angiography showed no extravasation of contrast, confirming successful closure of the subclavian artery.