Percutaneous closure of accidentally subclavian artery catheterization: time to change first line approach?

Abstract

Purpose: To present our experience and provide a literature review dissertation about the use of a suture-mediated percutaneous closure device (Perclose Proglide -PP- Abbott Vascular Inc., Santa Clara, CA, USA) to achieve hemostasis for unintended subclavian arterial catheterization during central venous line placement.

Materials & methods: Since October 2020, we have successfully treated four consecutive patients with a central venous catheter (8 to 12 French) in the subclavian artery. In each patient, we released a PP, monitoring its efficacy by performing a subclavian angiogram and placing, as a rescue strategy, an 8 mm balloon catheter near the entry point of the misplaced catheter. Primary outcome is technical and clinical success. Technical success is defined as absence of bleeding signs at completion angiography, while clinical success is a composite endpoint defined as absence of hematoma, hemoglobin loss at 12 and 24 h, and absence of procedure-related reintervention (due to vessel stenosis, pseudoaneurysm or distal embolization).

Results: Technical success was obtained in 75% of cases. In one patient a mild extravasation was resolved after 3 min of balloon catheter inflation. No early complications were observed for all patients.

Conclusions: PP showed a safe and effective therapeutic option in case of unintentional arterial cannulation. It can be considered as first-line strategy, as it does not preclude the possibility to use other endovascular approaches in case of vascular closure device failure.

Keywords: Central venous catheterisation; Endovascular repair; Subclavian artery injuries; Vascular closure device, Perclose Proglide.

Fig. 1

a Preliminary angiogram demonstrating the access site of the central venous catheter with the entry point located in between the vertebral artery and the thyrocervical trunk. An 8-mm diameter occlusion balloon catheter is placed in the subclavian artery near the entry point of the misplaced central venous catheter. b Angiogram executed after the deployment of the PP and during the tightening of the knot. On the upper side, the slipknot is located close to the arterial wall (arrow). c Final angiogram confirming the absence of active bleeding, stenosis or pseudoaneurysm