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Abstract Details

Iatrogenic Right Subclavian Artery injury after central line placement: Neuro-Endovascular treatment experience with Covered Stent
Cerebrovascular Disease and Interventional Neurology
Cerebrovascular Disease and Interventional Neurology Posters (7:00 AM-5:00 PM)
054
NA

Central venous access is a common and routine procedure performed in critically-ill patients with multiple known complications.

Arterial injury as a result of central line placement has been reported. In our case we describe an aberrant right subclavian artery injury as a complication of central line placement.

A covered stent was used to seal the vessel wall and preserve vessel patency.
A 73 year-old female with history of Hypertension and Diabetes mellitus who presented with hypertensive right basal ganglia bleed and intraventricular hemorrhage (IVH) extension. External Ventricular Drain (EVD) was emergently placed due to evolving hydrocephalus. The Primary team tried to place a central line access in the right Internal Jugular (IJ) and accidentally injured the right subclavian artery. Arterial Blood Gas (ABG) parameters obtained from the line were suggestive of arterial blood. Computed Tomography Angiography (CTA) head and neck showed small hematoma in the right neck region with adjacent tissue.
Cerebral angiogram was performed after right femoral and radial access and show an aberrant right subclavian with active contrast extravasation and pseudoaneurysm. This was treated with multiple trials of balloon angioplasty which were unsuccessful followed by Covered Stent; which resulted in immediate resolution of the contrast extravasation. Antiplatelet management with ASA was a challenge and was started two days after treatment. Follow up CTA chest revealed patent stent and no active contrast extravasation.

Neuro-endovascular intervention after iatrogenic arterial injury with covered stent is a feasible procedure to preserve vessel patency and to seal the vessel wall with an immediate resolution of the bleeding. This can be performed as an alternative method to conventional surgical treatment.

Per literature review covered stent for extracranial artery injuries is with an acceptable rate of morbidity and mortality.

Larger studies are required to determine the long term safety, stent patency and periprocedural complications.
Authors/Disclosures
Bader A. Alenzi, MD (St. Vincent Mercy health medical center)
PRESENTER 		Dr. Alenzi has nothing to disclose.
Saif A. Bushnaq, MD (Texas Tech University Health Sciences Center) Dr. Bushnaq has nothing to disclose.
Osama O. Zaidat, MD, FÂ鶹´«Ã½Ó³»­ (Neuroscience and Stroke Medical Director St Vincent Mercy Hospital) Dr. Zaidat has nothing to disclose.