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Case Reports
. 2019 Jul-Aug;69(4):413-416.
doi: 10.1016/j.bjan.2018.12.006. Epub 2019 Jul 26.

[Endovascular repair of subclavian artery injury secondary to internal jugular vein catheterization: case report]

[Article in Portuguese]
Jong Ho Kim  1 , Young Joon Kim  1 , Ji Su Jang  2 , Sung Mi Hwang  3
Affiliations
Case Reports

[Endovascular repair of subclavian artery injury secondary to internal jugular vein catheterization: case report]

[Article in Portuguese]
Jong Ho Kim et al. Braz J Anesthesiol. 2019 Jul-Aug.

Abstract

Background and objectives: Ultrasound-guided internal jugular vein catheterization is a common and generally safe procedure in the operating room. However, inadvertent puncture of a noncompressible artery such as the subclavian artery, though rare, may be associated with life-threatening sequelae, including hemomediastinum, hemothorax, and pseudoaneurysm.

Case report: We describe a case of the successful endovascular repair of right subclavian artery injury in a 75-year-old woman. Subclavian artery was injured secondary to ultrasound-guided right internal jugular vein catheterization under general anesthesia for orthopedic surgery.

Conclusion: Under general anesthesia several factors such as hypotension can mask the signs of subclavian artery injury. This case report indicates that clinicians should be aware of the complications of central venous catheterization and take prompt action.

Keywords: Cateterização da veia jugular interna; Correção endovascular; Endovascular repair; Internal jugular vein catheterization; Lesão da artéria subclávia; Subclavian artery injury.

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Figures

Figure 1
Figure 1
Chest radiograph. The chest radiograph shows a large hemothorax in the right thoracic cavity.
Figure 2
Figure 2
Angiography. The right subclavian artery (SCA) was injured, secondary to internal jugular vein cannulation. (A) Angiography shows extensive contrast media extravasations (arrow). (B) Selective Digital Subtraction Angiography (DSA) shows perforation of the SCA (arrow) and bleeding into the thoracic cavity.
Figure 3
Figure 3
Selective DSA. After stent graft implantation, there was no extravasation of contrast media, but blood flow to the vertebral and internal mammary arteries was blocked.
Figure 4
Figure 4
Two possible diagrams of the right subclavian artery (SCA) injury during Internal Jugular Vein (IJV) cannulation. (A) The guidewire was inserted in the IJV, but the dilator penetrated both the IJV and SCA. (B) The guidewire was inserted in the IJV, but the dilator bypassed the IJV and penetrated the SCA.
See this image and copyright information in PMC

References

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    1. Kulvatunyou N., Heard S.O., Bankey P.E. A subclavian artery injury, secondary to internal jugular vein cannulation, is a predictable right-sided phenomenon. Anesth Analg. 2002;95:564–566. - PubMed
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    1. Tokue H., Tsushima Y., Morita H., et al. Successful interventional management for subclavian artery injury secondary to internal jugular catheterization: a report of two cases. Cardiovasc Intervent Radiol. 2009;32:1268. - PubMed

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