A Case of Accidental Right Subclavian Artery Injury during Central Venous Catheterization through the Right Internal Jugular Vein

Riko Umeta＊	Tomohiro Nakajima＊	Yutaka Iba＊
Itaru Hosaka＊	Akihito Okawa＊	Naomi Yasuda＊
Tsuyoshi Shibata＊	Nobuyoshi Kawaharada＊

(Department of Cardiovascular Surgery, Sapporo Medical University＊, Sapporo, Japan)

An 88-year-old man was diagnosed with right renal pelvic carcinoma and underwent laparoscopic right nephroureterectomy. On postoperative day 3, he developed aspiration pneumonia and sepsis and received antibiotic therapy. A central venous catheter (CVC) with an outer diameter of 12 G was inserted via the right internal jugular vein for total parenteral nutrition. On the day after catheterization, pulsatility reverse flow was observed in its lumen, and arterial mispuncture was suspected. Enhanced computed tomography (eCT) revealed that the CVC was inserted at the right internal jugular vein and had penetrated the right subclavian artery, and the CVC tip was positioned at the ascending aorta. Our team discussed the strategy, including direct arterial suture, endovascular therapy, and a percutaneous closure device. Because the patient was too frail to endure direct arterial closure, we chose endovascular therapy. Under general anesthesia, we pulled the CVC. Immediately afterwards, we deployed a GORE® VIABAHN® VBX using the transaxillary approach. On postoperative day 1, eCT showed that the GORE® VIABAHN® VBX was positioned from the right subclavian artery bifurcation, and there were no complications of hemorrhage, endoleak, or migration. His postoperative course was uneventful, and he was transferred to another hospital on postoperative day 16.

 

Jpn. J. Cardiovasc. Surg. 51: 368-371 （2022)

Keywords：central venous catheter; arterial puncture; iatrogenic vascular injury; subclavian artery; peripheral intervention