Purpose: Retrospective review of the pattern and management techniques of arterial injuries related to central venous access with long-term outcomes. Materials and Methods: Between January 2007 and November 2017, a total of 20 patients (13 females) were included with the mean age of 63 (28-89 years) and mean body mass index of 25.75 (13.3-36.5). Venous access procedures included central venous catheter (CVC) placement, dialysis line insertion, or endovascular venous procedures. The study excluded patients who had arterial injuries related to arterial access, such as postarterial line placement, postangiography, or percutaneous coronary interventions. Results: Iatrogenic arterial injuries occurred after attempted venous access procedures involving the common femoral vein (n = 18) and subclavian vein (n = 2). Injuries were related to CVC placement (n = 5), temporary dialysis catheter (n = 14), and inferior vena cava filter insertion (n = 1). Nine patients had transarterial venous catheter insertion complicated by active bleeding from pseudoaneurysm and arteriovenous fistula. Other injuries included isolated fistula (n = 3), isolated pseudoaneurysm (n = 4), isolated branch injury (n = 2), and intra-arterial insertion (n = 2). Endovascular management included stent-graft placement (n = 14), embolization of bleeding vessel (n = 2), and thrombin injection for pseudoaneurysm (n = 2). Conservative management with manual compression achieved hemostasis in two patients. Technical success was achieved in 100%. One patient required repeat angiography and embolization of bleeding branch vessel following stent-graft placement to control bleeding fistula and pseudoaneurysm. Clinical success was achieved in all patients. Procedure-related complications included puncture site hematoma (n = 1) and partially occlusive thrombus/spasm of deep femoral artery after stent-graft placement. Six patients (33%) died within 20 days after the procedure (3-20 days) due to other comorbidities. Three additional patients (16%) died during the same hospital admission at the time of the procedure (38-114 days). There were no reported complaints related to possible stent-graft stenosis or occlusion at mean follow-up time of 5 years (50 days-8.64 years) in all seven patients who survived after stent-graft placement procedure. Conclusion: Despite technically successful endovascular management of arterial injuries related to venous access in critically ill patients, the mortality rate remains high due to other comorbidities. Allowing for the small sample size, stent-graft placement for arterial injuries in this cohort of patients appears to be an effective option with high long-term patency rate.

and femoral vein (n = 1). Nine cases were performed under local and 3 under general anesthesia. Single-lumen endoluminal balloon dilatation is done in eight cases and double-lumen dilatation in four cases. Low profile 0.018" or 0.014" balloons ranging from 5-8 mm were used. Results: All catheters were removed safely without any minor or major adverse events. In one case, the catheter was shredded completely but removed over the balloon with no complications. Conclusion: Minimally invasive endoluminal balloon dilatation of tunneled dialysis catheter is a safe and effective technique for removing embedded catheters.