ABSTRACT
Accidental supra-aortic arterial cannulation during central venous catheter (CVC) insertion is a rare and serious complication associated with risk of vascular and neurologic complications. The aim of this study is describing our 6 cases experience and propose a management algorithm. We retrospectively evaluated the diagnosis and treatment of six patients arrived at our Department for accidental supra-aortic arterial cannulation during CVC insertion. They underwent Doppler Ultrasonography (DUS) or Computed Tomography Angiography (CTA) to confirm the arterial damage and to decide the correct therapeutic pathway. Four patients underwent DUS as the shallow location of injured arteries and 2 patients CTA because of the arterial damage deeply located. Surgical procedure with direct arterial suture was performed in four patients. Endovascular treatment with stent graft deployment was carried out in two patients. All procedures were conducted successfully: technical success (immediate hemostasis and vessel patency) was obtained in 100% of the cases. Postoperative imaging (DUS or CTA) confirmed the absence of arterial bleeding and the arterial patency. No perioperative mortality or complications occurred. After a careful review of literature and our case series, we proposed an algorithm to delineate the optimal treatment strategy, explaining that early and careful diagnosis (by DUS or CTA) and prompt repair appear crucial to achieve good outcomes and clarifying that an endovascular technique (stent graft placement or vascular closure device) seems to be the best treatment in these cases. Finally, an open surgical technique could be indicated in case of common carotid artery injury and concurrent catheter passing through the target vein.
Subject(s)
Algorithms , Arteries/surgery , Blood Vessel Prosthesis Implantation , Catheterization, Central Venous/adverse effects , Decision Support Techniques , Endovascular Procedures , Suture Techniques , Vascular System Injuries/surgery , Aged , Aged, 80 and over , Arteries/diagnostic imaging , Arteries/injuries , Blood Vessel Prosthesis , Blood Vessel Prosthesis Implantation/adverse effects , Blood Vessel Prosthesis Implantation/instrumentation , Catheterization, Central Venous/instrumentation , Catheters, Indwelling , Central Venous Catheters , Clinical Decision-Making , Computed Tomography Angiography , Endovascular Procedures/adverse effects , Endovascular Procedures/instrumentation , Female , Hemostasis , Humans , Male , Middle Aged , Retrospective Studies , Stents , Suture Techniques/adverse effects , Treatment Outcome , Ultrasonography, Doppler , Vascular Patency , Vascular System Injuries/diagnostic imaging , Vascular System Injuries/etiologyABSTRACT
INTRODUCTION: A 90-year-old patient was admitted with a hemorrhagic shock from a huge ruptured abdominal aortic aneurysm with an unfavourable infrarenal aortic neck and a horseshoe kidney (HSK). REPORT: We decided on an open surgical approach: the HSK isthmus was sectioned with an Endo GIA 45 mm, and we performed a suprarenal aortic cross-clamping and an aortic graft reconstruction. Postoperatively, no urinary leakage was detected, and renal function showed no impairment. The patient died on the 10th postoperative day from pneumonia. CONCLUSION: We believe that the sectioning of the HSK isthmus with Endo GIA is a fast and simple maneouvre.
