RESUMO
The subclavian vein is an uncommon route for tunneled hemodialysis catheter (tHDC) placement because of its potency for future dialysis access. However, when favored access routes have been exhausted because of repeated catheterization or limited life expectancy, the subclavian vein can be used for urgent hemodialysis. A subclavian catheterization has a technical problem. The subclavian vein often forms a right angle with the vena cava, and advancing stiff peel-away sheath can cause a vascular injury. However, raising the patient's arm can alter the position of the guidewire and, therefore, change the angle of the vein favorable for tHDC placement. Herein, we report two patients who underwent subclavian catheterization; one experienced an injury to the superior vena cava after undergoing the conventional procedure, whereas the other patient with raised arm during the catheterization procedure had safe catheter placement.
RESUMO
Active bleeding from a small branch of the femoral artery can occur after catheterisation and may be difficult to treat. Stent-graft placement or embolisation after catheterisation can be a useful solution. However, stent-graft placement is often challenging for the treatment of bleeding around bifurcations, and it may be limited by available stent-graft sizes during emergencies. Embolisation can also be difficult if the vessel diameter is too small to catheterise or if the branching angle is too acute. Thrombin injection is accepted as a safe and effective treatment for iatrogenic or traumatic pseudoaneurysm. However, large haematomas can deter ultrasonographic guidance. We herein report the successful treatment of active bleeding from a small branch of the superficial femoral artery after femoral access by percutaneous direct puncture under angiographic guidance and thrombin injection at the bleeding focus.
