Lee Kyung Bae, Pyun Alyssa J, Praeger Jonathan, Ziegler Kenneth R, Han Sukgu M
Divisions of Vascular Surgery, Keck Medical Center of University of Southern California, Los Angeles, CA, USA.
Yonsei University College of Medicine, Seoul, Korea.
Vasc Specialist Int. 2022 Jun 30;38:22. doi: 10.5758/vsi.220015.
Iatrogenic innominate vein injuries are rare complications associated with internal jugular venous catheters. These complications are accompanied by high morbidity and mortality rates in patients with severe underlying medical conditions. Without proper treatment, emergency surgery may be needed due to acute cardiac tamponade or hemothorax. Endovascular repair can be advantageous for patients with significant medical comorbidities. Herein, we report the case of a 62-year-old female with an iatrogenic injury to the innominate vein at the subclavian vein and internal jugular confluence due to a malpositioned left internal jugular catheter. A customized fenestrated endograft was positioned with fenestration oriented to the internal jugular vein and a new tunneled catheter was inserted across the fenestration into the superior vena cava upon removal of the malpositioned catheter. In addition, a brachio-basilic arteriovenous fistula was created. At one month follow-up, the patient had a palpable thrill over the arteriovenous fistula and a functioning tunneled catheter.
医源性无名静脉损伤是与颈内静脉导管相关的罕见并发症。在患有严重基础疾病的患者中，这些并发症伴随着高发病率和死亡率。若未得到妥善治疗，因急性心脏压塞或血胸可能需要进行急诊手术。对于有严重内科合并症的患者，血管内修复可能具有优势。在此，我们报告一例62岁女性患者，因左颈内静脉导管位置不当，在锁骨下静脉与颈内静脉汇合处发生医源性无名静脉损伤。定制的开窗型腔内移植物被放置，开窗朝向颈内静脉，在移除位置不当的导管后，一根新的隧道式导管通过开窗插入上腔静脉。此外，还建立了肱-贵要动静脉内瘘。在1个月的随访中，患者的动静脉内瘘处可触及震颤，且隧道式导管功能良好。
