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

Abstract

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.

A case of endovascular treatment for iatrogenic left vertebral artery injury due to central line catheter placement

“…Generally, treating arterial injury during CVC placement can be classified into three approaches: catheter removal and direct pressure, open surgery, and endovascular treatment. 4 , 5 , 6 , 7 , 8 , 9 Anatomically, the VA can be divided into four segments (V1-V4). 10 A previous study reported that the V1 segment had a predilection for injury, followed by the V2 segment.…”

“…11 In cases of arteriovenous fistulas, endovascular techniques have been preferred for treatment in recent years. 4 , 5 , 6 , 7 , 8 , 9 However, surgical excision of aneurysms remains the mainstay of treatment. 4 , 11 In our patient, injury to the V1 to V2 segment of the left VA was suspected and was expected to be difficult to compress directly.…”