Department of Emergency Vascular Surgery, Azienda Ospedaliero-Universitaria Ospedali Riuniti Ancona, Ancona, Italy.
Department of Vascular Surgery, Azienda Ospedaliero-Universitaria Ospedali Riuniti Ancona, Ancona, Italy.
Ann Vasc Surg. 2021 Aug;75:308-314. doi: 10.1016/j.avsg.2021.02.012. Epub 2021 Apr 2.
Accidental supra-aortic arterial cannulation during central venous catheter (CVC) insertion is a rare and serious complication associated with risk of vascular and neurologic complications. The aim of this study is describing our 6 cases experience and propose a management algorithm. We retrospectively evaluated the diagnosis and treatment of six patients arrived at our Department for accidental supra-aortic arterial cannulation during CVC insertion. They underwent Doppler Ultrasonography (DUS) or Computed Tomography Angiography (CTA) to confirm the arterial damage and to decide the correct therapeutic pathway. Four patients underwent DUS as the shallow location of injured arteries and 2 patients CTA because of the arterial damage deeply located. Surgical procedure with direct arterial suture was performed in four patients. Endovascular treatment with stent graft deployment was carried out in two patients. All procedures were conducted successfully: technical success (immediate hemostasis and vessel patency) was obtained in 100% of the cases. Postoperative imaging (DUS or CTA) confirmed the absence of arterial bleeding and the arterial patency. No perioperative mortality or complications occurred. After a careful review of literature and our case series, we proposed an algorithm to delineate the optimal treatment strategy, explaining that early and careful diagnosis (by DUS or CTA) and prompt repair appear crucial to achieve good outcomes and clarifying that an endovascular technique (stent graft placement or vascular closure device) seems to be the best treatment in these cases. Finally, an open surgical technique could be indicated in case of common carotid artery injury and concurrent catheter passing through the target vein.
中心静脉导管（CVC）插入过程中意外发生主动脉外动脉插管是一种罕见且严重的并发症，可导致血管和神经并发症的风险。本研究旨在描述我们的 6 例经验，并提出一种管理算法。我们回顾性评估了 6 例因 CVC 插入过程中意外发生主动脉外动脉插管而到我科就诊的患者的诊断和治疗。他们接受了多普勒超声（DUS）或计算机断层血管造影（CTA）检查以确认动脉损伤，并决定正确的治疗途径。4 例患者因损伤动脉位置较浅而行 DUS 检查，2 例患者因动脉损伤位置较深而行 CTA 检查。4 例患者行外科手术直接动脉缝合，2 例患者行血管内治疗支架移植。所有手术均成功进行：100%的病例均获得技术成功（立即止血和血管通畅）。术后影像学（DUS 或 CTA）证实无动脉出血和动脉通畅。无围手术期死亡或并发症发生。在仔细回顾文献和我们的病例系列后，我们提出了一种算法来制定最佳治疗策略，解释说早期和仔细的诊断（通过 DUS 或 CTA）和及时修复对于获得良好的结果至关重要，并澄清血管内技术（支架移植或血管闭合装置）在这些情况下似乎是最佳治疗方法。最后，如果发生颈总动脉损伤和导管同时穿过靶静脉，则可考虑采用开放式手术技术。
