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Mortality among patients with rAAA and preoperative cardiac arrest is high but not prohibitive. Aortic repair should not be withheld from such patients who are otherwise reasonable candidates for intervention, provided resources for emergent aortic repair are available.

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was consulted. Because the patient had heparin-induced thrombocytopenia with a platelet count of 30,000, she was taken to surgery for open removal (Fig 2, A). After catheter removal, with distal clamping, there was no bleeding from the carotid artery puncture hole. A small transverse arteriotomy removed a 13-mm  3-mm well-formed clot (Fig 2, B). The jugular and carotid vessels were both repaired primarily, with good flow maintained (Fig 2, C). The patient recovered without any additional neurologic deficits. Conclusions: Ultrasound guidance alone is not sufficient to prevent vascular complications of central line placement. An understanding of vascular anatomy can help prevent such complications and properly diagnose them on chest X-ray imaging. Open surgical removal prevented embolization of a large pericatheter clot that would have occurred with simple removal.