Henry Tan Chor Lip, Huei Tan Jih, Yuzaidi Mohamad, Safri Lenny Suryani, Krishna K, Rizal Imran Alwi, Mohamad Azim Md Idris, Harunarashid Hanafiah
Trauma Surgery Unit, Department of Surgery, Hospital Sultanah Aminah, Johor Bahru, Malaysia; Vascular Surgery Unit, Department of General Surgery, Faculty of Medicine, National University of Malaysia Medical Centre, Kuala Lumpur, Malaysia.
Trauma Surgery Unit, Department of Surgery, Hospital Sultanah Aminah, Johor Bahru, Malaysia; Vascular Surgery Unit, Department of General Surgery, Faculty of Medicine, National University of Malaysia Medical Centre, Kuala Lumpur, Malaysia.
Chin J Traumatol. 2020 Feb;23(1):29-31. doi: 10.1016/j.cjtee.2019.10.001. Epub 2019 Oct 21.
Incidence of inadvertent arterial puncture secondary to central venous catheter insertion is not common with an arterial puncture rate of <1%. This is due to the advancements and wide availability of ultrasound to guide its insertion. Formation of arteriovenous fistula after arterial puncture is an unexpected complication. Till date, only five cases (including this case) of acquired arteriovenous fistula formation has been described due to inadvertent common carotid puncture. The present case is a 26-year-old man sustained traumatic brain injuries, chest injuries and multiple bony fractures. During resuscitative phase, attempts at left central venous catheter via left internal jugular vein under ultrasound guidance resulted in inadvertent puncture into the left common carotid artery. Surgical neck exploration revealed that the catheter had punctured through the left internal jugular vein into the common carotid artery with formation of arteriovenous fistula. The catheter was removed successfully and common carotid artery was repaired. Postoperatively, the patient recovered and clinic visits revealed no neurological deficits. From our literature review, the safest method for removal is via endovascular and open surgical removal. The pull/push technique (direct removal with compression) is not recommended due to the high risk for stroke, bleeding and hematoma formation.
中心静脉导管插入术继发的意外动脉穿刺并不常见，动脉穿刺率<1%。这归因于超声引导其插入的技术进步和广泛应用。动脉穿刺后形成动静脉瘘是一种意外并发症。迄今为止，因意外颈总动脉穿刺导致获得性动静脉瘘形成的病例（包括本病例）仅报道了5例。本病例为一名26岁男性，患有创伤性脑损伤、胸部损伤和多处骨折。在复苏阶段，在超声引导下经左颈内静脉尝试插入左中心静脉导管时，意外穿刺入左颈总动脉。颈部手术探查发现导管已穿破左颈内静脉进入颈总动脉并形成动静脉瘘。导管成功移除，颈总动脉得以修复。术后，患者康复，门诊检查未发现神经功能缺损。根据我们的文献综述，最安全的移除方法是通过血管内和开放手术移除。由于中风、出血和血肿形成的风险较高，不推荐采用牵拉/推挤技术（直接压迫移除）。
