Covered Stenting as Bail-Out Technique for Central Venous Catheter Malposition Within the Brachiocephalic Trunk

Abstract

Central venous catheter (CVC) insertion with ultrasound guidance is routine clinical practice in the critically ill patient. Arterial malposition is serious and may lead to severe complications such as hemorrhage, stroke, or death. We describe a bail-out technique for removal of right-sided CVC that was mispositioned into the brachiocephalic trunk (BCT) at the origin of the right common carotid artery (CCA). Covered stenting of the BCT extending into the CCA in combination with plug embolization of the right subclavian artery was utilized.

Carotid-Esophageal Fistula Treated By Endovascular Approach

“…Treatment options for cases of CEF include vascular surgery with vessel reconstruction, 8 artery ligation or endovascular treatment. 7,9 Vascular open surgery was not attempted in our case, considering the acute anemia associated with smaller blood volume in children. Endovascular treatment offers several options, such as conventional and covered stents, flow diverters, and embolization with detachable coils or liquid embolic agents.…”

Endovascular Therapy for Isolated Brachiocephalic Pseudoaneurysm

“… 1 ) Although a few true aneurysms due to atherosclerosis have been reported, cases of pseudoaneurysms due to traumatic, iatrogenic, or infectious events were also found. 2 , 3 ) However, there remains no standardized treatment for this disease. Case reports have described use of open thoracotomy, endovascular therapy using kissing covered stents technique from the brachiocephalic artery into the common carotid and subclavian arteries, and hybrid treatment using a covered stent and artificial graft.…”

“…Faraj et al reported a bailout technique using φ 7 mm VBX (from the brachiocephalic artery into the common carotid artery) for iatrogenic brachiocephalic injury. 3 ) Meanwhile, Hu et al reported using the kissing VIABAHN stent technique for brachiocephalic pseudoaneurysm. 6 ) The short term results of these reports were deemed to be satisfactory.…”

Endovascular Repair of a Common Carotid Artery Perforation during Pacemaker Insertion

“…8 Several different strategies in the management of vascular injuries occurring during the placement of jugular or subclavian central venous catheters are reported; however, a consensus on a standardized damage control protocol has not been published so far. 9,10 In case of arterial perforation, 3 possible bail-out techniques are possible: extraction and external compression, open surgical arterial repair, and endovascular treatment, 11,12 using percutaneous closure devices 13,14 or covered stent deployment. 12 When the injury is caused by 7 Fr or greater catheters and when the puncture site location is too far from the skin, the extraction and compression technique is associated with significantly higher morbidity (stroke, suddenly expanding hematoma causing airway compression, false aneurysm development) and mortality, if compared with both surgical and endovascular approach.…”