Acute Management of Iatrogenic Injury to Vertebral Artery With Central Venous Catheter in a Critically Ill Patient

Rayes, Aisha Al; Khattak, Yasir Jamil; Qafani, Avdullah; Anwar, Muhammad; Sibaie, Ayman Al

doi:10.7759/cureus.9956

Cited by 6 publications

(6 citation statements)

References 21 publications

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“…They also identify 46 prior cases of vertebral artery catheterization during CVC placement, but only three cases of successful parent artery preservation with endovascular stent placement [8][9][10][11][12]. Most recently, Rayes et al presented a case in which they utilized an endovascular stent for vertebral artery preservation following iatrogenic injury [13]. Other endovascular treatments include embolization via either balloon or coil methods [14][15][16][17].…”

Section: Discussionmentioning

confidence: 99%

Erroneous Central Venous Catheter Placement: Multidisciplinary Primary Surgical Repair of the Vertebral Artery

Opperman¹,

Thompson²,

Surdell³

2022

Cureus

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Central venous catheters are a common practice in critical care medicine. These lines are of particular importance when a patient needs large volume resuscitation or medications that cannot be infused through a peripheral line. Even though central venous catheters are frequently utilized, they are associated with potentially significant risks that one must be aware of when attempting placement. The anatomy and pertinent complications are key for any healthcare professional to be aware of during this procedure. As such, vascular injury has been described in the literature, but vertebral artery injury and common repair techniques are less common. Primary repair of the second vertebral artery segment is infrequently detailed in the literature and this report describes pertinent case details and plan of action for identification and repair of iatrogenic vertebral artery injury following catheter placement.

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Section: Discussionmentioning

confidence: 99%

Erroneous Central Venous Catheter Placement: Multidisciplinary Primary Surgical Repair of the Vertebral Artery

Opperman¹,

Thompson²,

Surdell³

2022

Cureus

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“…However, certain limitations exist, that is, if the affected vertebral artery is the main blood supply, stenting should be considered, which leads to distal embolization risk. [ 2 ] Furthermore, based on the vertebral artery union angle, the contralateral approach may be difficult. In both cases, although this method may not be possible based on the patient’s vascular factors, we believe that it is important to understand the blood flow and maneuvers potentially causing distal embolization, and accordingly, develop procedures to avoid them.…”

Section: Discussionmentioning

confidence: 99%

Removal of a central venous catheter penetrating the vertebral artery: A case report on endovascular treatment for blunt cerebrovascular injury

Kaneko¹,

Ikeda²,

Uezato³

et al. 2022

Surgical Neurology International

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Background: Anticoagulation and endovascular therapy are commonly used treatment methods for blunt cerebrovascular injury (BCVI). However, in certain cases, the perforating objects damaging the blood vessels need to be removed. In such cases, stenting and coil embolization have been reported to be useful. Furthermore, we believe that distal embolization can arrest bleeding at the perforation site when using such treatments. In support of this procedure, we report a case of successful BCVI treatment using distal embolization through contralateral side and proximal protection. Case Description: A 61-year-old man had an accidental placement of a central venous catheter that resulted in the perforation of the vertebral artery. Endovascular treatment was performed to remove the catheter and prevent bleeding during extraction. For this treatment, we used the method of distal embolization through the contralateral approach and proximal protection with a microballoon catheter followed by removal of the perforating catheter and additional embolization of the bleeding point under controlled blood flow. Conclusion: Under distal and proximal protections, we were able to successfully remove the perforating catheter without bleeding and ischemic complications. While treating BCVI, which requires the removal of perforating material, attention should be paid to the various protection methods and procedures.

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“…The number of patients in whom mispuncture of the VA with a catheter became clear in the acute phase, leading to treatment, is small. 4 , 5) Al Rayes et al reported that stent-grafting for mispuncture of the right VA with a central venous catheter led to a favorable outcome, but there was no description of the postoperative course. 5) Tasopoulou et al presented a patient with a large subcutaneous hematoma related to mispuncture of the right VA on dialytic catheter insertion and reported that treatment with a covered stent resulted in angiographic cure.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3] The number of case reports in which acute-phase mispuncture required treatment is limited and there are no treatment guidelines. 4,5) We report a patient in whom an 8-Fr. sheath was misinserted into the right VA through the right IJV immediately before open heart surgery and endovascular therapy was performed immediately after mispuncture, leading to a favorable outcome.…”

Section: Introductionmentioning

confidence: 98%

Acute Endovascular Therapy for Iatrogenic Vertebral Artery Injury: A Case Report

Ito

Kojima

Yamanoi

et al. 2022

JNET

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Accidental puncture of the vertebral artery (VA) by central venous catheters and other devices has been reported as a rare complication. We performed endovascular therapy in the acute phase in a patient in whom a largecaliber sheath was misinserted into the VA.Case Presentation: A 68-year-old woman scheduled for open heart surgery had an 8-Fr. sheath inserted through the right internal jugular vein (IJV). This sheath penetrated the IJV and was misplaced in the V1 segment of the right VA.Endovascular therapy was performed. First, a 9-Fr. balloon-guiding catheter (BGC) was inserted and a 0.035-inch guidewire was pulled through it and the 8-Fr. sheath misinserted into the right VA. A 6-Fr. guiding catheter was inserted into the left VA and the microcatheter reached distal of where the sheath was inserted via the basilarunion. Then, the same area was embolized with coils to block retrograde blood flow. The BGC was then guided to the right VA origin using a pull-through wire while the 8-Fr. sheath was carefully withdrawn. The sheath was pulled back until just before exiting the VA and additional coils were placed via a microcatheter inserted into the BGC to occlude the right VA. Postoperatively, the patient had no neurological findings. Conclusion:We reported a rare case of iatrogenic VA injury. Attention to hemorrhage and intracranial blood flow resulted in a favorable outcome.

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Acute Management of Iatrogenic Injury to Vertebral Artery With Central Venous Catheter in a Critically Ill Patient

Cited by 6 publications

References 21 publications

Erroneous Central Venous Catheter Placement: Multidisciplinary Primary Surgical Repair of the Vertebral Artery

Erroneous Central Venous Catheter Placement: Multidisciplinary Primary Surgical Repair of the Vertebral Artery

Removal of a central venous catheter penetrating the vertebral artery: A case report on endovascular treatment for blunt cerebrovascular injury

Acute Endovascular Therapy for Iatrogenic Vertebral Artery Injury: A Case Report

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