![]() ![]() Also, note the mass effect over the proximal right internal mammary artery (white arrowhead) by the external collagen plug component. The distal right subclavian artery (white star) and the dominant right vertebral artery (black arrow) are widely patent with no active bleeding. The entry point of the misplaced catheter is noted just proximal to RIMA and patent right subclavian, right vertebral, and RIMA.įigure 2: A right brachiocephalic artery angiogram after line removal and successful application of angioseal vascular closure device. The Right common femoral artery access was obtained, and angiogram of right brachiocephalic artery was performed (Figure 1). The right neck, chest wall, and both groins were prepped and draped in a sterile fashion inside the interventional radiology suit. An informed consent was obtained from the patient family. Giving the patient condition, and the site of arterial puncture, the plan for treatment was using a percutaneous closure devise (Angioseal®) and was based on consensus between the vascular surgeon, an intensive care unit (ICU) doctor, and interventional radiologist.Īdditional to the Angioseal, 8 mm and 10 mm balloons were made available and ready if needed. Then, IR team was consulted for endovascular line removal and arterial repair. ![]() There was no other vascular injury, extravasations or hematoma. The tract distance from skin entry to the artery puncture site was approximately 8 cm. The right vertebral artery was dominant with mild atherosclerosis at its origin. The catheter tip noted within the Right Brachiocephalic artery with no associated thrombus around it and the entry site was just distal to the ostium of right internal mammary artery (RIMA) and opposing the origin of the right vertebral artery. MR angiogram of head and neck showed right PCA, right superior cerebellar artery (SCA) territories sub-acute infarctions, with confirmation of the misplaced central line into the right subclavian artery. ![]() urgent CT-brain was performed showing an acute right posterior cerebral artery (PCA) stroke. Few hours later, the patient level of consciousness was deteriorated with drop of her Glasgow Coma Scale (GCS). a consensus meeting was set including Vascular surgery, Interventional radiology and intensive care unit for the possible management measures Immediately, the vascular surgeon was consulted, and he advised to keep the line in place, labeled "not for use", and to set a plan for removal. The patient developed Right posterior cerebral artery territory stroke few hours later confirmed by CT brain and CT angiogram of the head and neck. The line was secured in place and labeled not for use. The doctors have noticed an arterial blood back flow and they suspected an arterial puncture. The primary assessment mandates a central venous access for rapid Intravenous hydration and antibiotics treatment.Īt the emergency room, a 7-Fr Triple-lumen central line was inserted utilizing a right sub clavicular approach and using the anatomical landmarks technique. This is a 90-years-old lady known diabetic and hypertensive, who presented to emergency room with signs and symptoms of septic shock on top of pneumonia and urinary tract infection. Stroke is a rare complication encountered in our case due to the misplaced central line. We report a case in which the patient condition command the use of closure devise over other surgical and endovascular options and with successful hemostasis. ![]() Arterial misplacement of the venous central line catheter is not an uncommon early complication which carries devastating and fetal consequences. ![]()
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