Journal of Vascular and Endovascular Therapy

A Novel Approach to the Management of Inadvertent Subclavian Artery Cannulation Using Angio-Seal Closure Device: A Case Series

Background: Inadvertent arterial cannulation is a wellknown complication of subclavian central venous catheterization. While this complication at other sites can be managed through prompt identification of catheter misplacement, followed by catheter removal and application of manual compression, subclavian artery cannulation offers a unique challenge to effective management due to its incompressible anatomic location. Current treatment options for inadvertent subclavian artery cannulation include direct surgical repair or endovascular treatment with stent graft placement. We report 3 cases of patients with inadvertent subclavian artery cannulation which was safely and effectively managed utilizing a novel technique using the 8Fr Angio-Seal vascular closure device.

Methods: Three patients with inadvertent puncture of the subclavian artery during Central Venous Catheter (CVC) placement were treated with 8Fr Angio-Seal deployment. Patient 1 is a 53-year-old found hemodynamically unstable and unresponsive, undergoing emergent central line placement in the emergency department. Patient 2 is a 29- year-old female who was a burn patient undergoing central line placement in conjunction with planned skin graft placement. Patient 3 is a 57-year-old female with congestive heart failure who underwent central line placement at an outside hospital and transferred to a quaternary center for inadvertent subclavian artery cannulation after central line placement attempt.

Results: Management of inadvertent subclavian artery cannulation was safely and successfully achieved utilizing the 8Fr Angio-Seal vascular closure device to create a mechanical seal in all three patients. The closure device can be deployed into the subclavian arteriotomy utilizing the original 7Fr central venous catheter. The technique is immediately effective, requires a few minutes for deployment and was performed at bedside. Subsequent imaging revealed patent and intact subclavian artery.

Conclusions: Utilization of Angio-Seal vascular closure offers a rapid, inexpensive, and efficient way to repair inadvertent subclavian artery cannulations by triple lumen catheters at bedside in the ICU, ER, and OR. This percutaneous approach offers a shorter recovery time and avoids operative complications of open surgical repair.

Author(s): Arun Goyal*, Igor A Laskowski, Romeo B Mateo, Nicole Lin, Cynthia Lin and Sateesh C Babu

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