Division of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA.
J Neurosurg. 2011 Jan;114(1):146-52. doi: 10.3171/2009.10.JNS09940. Epub 2009 Nov 20.
Inadvertent catheterization of brachiocephalic arteries (carotid artery, subclavian artery, or vertebral artery) during attempted placement of a central venous catheter can have potentially disastrous complications. While removal of the catheter in the operating room is almost always an option, there are circumstances in which a less invasive approach may be more appropriate. The authors present their experience using endovascular techniques for removal of inadvertently placed central venous catheters to elucidate potential options for successful nonsurgical management.
The authors reviewed their database of interventional procedures that occurred between January 1, 2000, and February 1, 2009. All cases referred for management of suspected brachiocephalic arterial catheterization or arterial injury after attempted placement of a central venous catheter were included. Medical records and radiological imaging were reviewed to determine patient demographics, clinical situation, methods for removal, as well as clinical and imaging follow-up.
A total of 13 patients, ranging in age from 31 to 88 years old, were referred to interventional radiology for management of suspected inadvertent arterial catheterization of the brachiocephalic arteries. Angiography confirmed arterial catheterization in 9 patients. Three patients were referred after developing uncontrolled hemorrhage or expanding hematomas following attempted catheterization. One patient who had an arterial waveform after placement of an internal jugular catheter was found to have early venous filling from a dialysis fistula requiring no intervention. Ten patients were treated in the interventional suite using angiographically monitored manual pressure (1 patient), balloon tamponade (3 patients), use of a percutaneous closure device (1 patient), stent grafting (4 patients), or embolization of the injured vessel alone (1 patient). One patient was taken to the operating room for removal of the inadvertently placed catheter due to vessel thrombosis. No procedural complications were encountered, and no patient required sacrifice of a major brachiocephalic vessel.
Angiographic evaluation of patients who underwent inadvertent catheterization of brachiocephalic arteries or their branches allowed successful endovascular treatment or excluded the need for intervention in 12 (92%) of 13 patients. The choice and use of specific endovascular techniques should be dictated by patient factors and the vessel inadvertently catheterized.
在尝试放置中心静脉导管时，无意中将导管插入头臂动脉（颈动脉、锁骨下动脉或椎动脉）可能会导致严重的并发症。虽然在手术室中取出导管几乎总是一种选择，但在某些情况下，采用侵入性较小的方法可能更为合适。作者介绍了他们使用血管内技术取出无意中放置的中心静脉导管的经验，以阐明成功的非手术治疗的潜在选择。
作者回顾了他们 2000 年 1 月 1 日至 2009 年 2 月 1 日期间进行的介入性操作数据库。所有因怀疑头臂动脉导管插入或试图放置中心静脉导管后动脉损伤而转介介入放射科的病例均包括在内。回顾了病历和影像学检查结果，以确定患者的人口统计学特征、临床情况、取出方法以及临床和影像学随访。
共 13 例患者，年龄 31 至 88 岁，因怀疑头臂动脉意外动脉导管插入而被转介至介入放射科。血管造影术在 9 例患者中证实了动脉导管插入。3 例患者在试图置管后出现无法控制的出血或血肿扩大后被转介。1 例颈内静脉导管放置后出现动脉波形的患者，由于动静脉瘘导致早期静脉充盈，无需介入治疗。10 例患者在介入室中使用血管造影监测的手动压力（1 例）、球囊填塞（3 例）、使用经皮闭合装置（1 例）、支架移植（4 例）或单独栓塞受伤血管（1 例）进行治疗。1 例患者因血管血栓形成而被送往手术室取出无意中放置的导管。没有发生手术并发症，也没有患者需要牺牲主要的头臂血管。
对意外插入头臂动脉或其分支的患者进行血管造影评估，使 13 例患者中的 12 例（92%）能够成功进行血管内治疗或排除需要介入治疗的可能。具体血管内技术的选择和使用应根据患者因素和无意中插入的血管来决定。
