Tamaoki Yuto, Kamidani Ryo, Okada Hideshi, Miyake Takahito, Suzuki Kodai, Yoshida Takahiro, Kumada Keisuke, Yoshida Shozo, Ogura Shinji
Advanced Critical Care Center, Gifu University Hospital, 1-1, Yanagido, Gifu city, Gifu 501-1194, Japan.
Patient Safety Division, Gifu University Hospital, 1-1, Yanagido, Gifu city, Gifu 501-1194, Japan.
Radiol Case Rep. 2024 Apr 13;19(7):2579-2584. doi: 10.1016/j.radcr.2024.03.025. eCollection 2024 Jul.
Subclavian artery injuries during internal jugular vein puncture when attempting central venous catheter insertion are rare. A 60-year-old man undergoing treatment for neuromyelitis optica with paralysis and sensory loss developed a complication during catheter placement into his right internal jugular vein for plasmapheresis. His previous physician felt resistance and discontinued the procedure. The patient later developed mild dyspnea and dysphagia. Computed tomography scans indicated thrombus formation and tracheal deviation. Contrast-enhanced computed tomography scans showed right subclavian artery injury with extravasation and a large pseudoaneurysm. Following transferal to our hospital, he was stable and asymptomatic; however, contrast-enhanced computed tomography scans showed a pseudoaneurysm located proximal to the right subclavian artery. Considering challenges with compression hemostasis and the invasiveness of open surgery, endovascular treatment was selected using a VIABAHN stent graft. A balloon occlusion test of the right vertebral artery was performed to assess stroke risk. Prophylactic embolization of the right vertebral artery, internal thoracic artery, and thyrocervical trunk were performed to prevent a type 2 endoleak. On hospital day 5, our patient showed no postoperative complications and was transferred to the referring hospital. Follow-up imaging showed the graft was intact with no pseudoaneurysm, confirming successful treatment. Endovascular treatment with a stent graft is highly effective for peripheral artery injuries. Using a balloon occlusion test to assess collateral blood flow and stroke risk is essential pretreatment, especially when a graft might occlude the vertebral artery. Balloon occlusion tests are recommended when planning treatment for iatrogenic and other types of subclavian artery injuries.
在尝试插入中心静脉导管时，颈内静脉穿刺过程中锁骨下动脉损伤较为罕见。一名60岁患有视神经脊髓炎且伴有瘫痪和感觉丧失的男性患者，在进行血浆置换将导管置入右颈内静脉时出现了并发症。其先前的医生感觉到有阻力，便停止了操作。该患者随后出现轻度呼吸困难和吞咽困难。计算机断层扫描显示有血栓形成和气管移位。增强计算机断层扫描显示右锁骨下动脉损伤伴造影剂外渗及一个大的假性动脉瘤。转至我院后，他病情稳定且无症状；然而，增强计算机断层扫描显示在右锁骨下动脉近端有一个假性动脉瘤。考虑到压迫止血的难度以及开放手术的侵入性，选择了使用VIABAHN覆膜支架进行血管内治疗。对右椎动脉进行了球囊闭塞试验以评估中风风险。对右椎动脉、胸廓内动脉和甲状腺颈干进行了预防性栓塞以预防Ⅱ型内漏。住院第5天，我们的患者未出现术后并发症，并转至转诊医院。随访影像学检查显示移植物完好，无假性动脉瘤，证实治疗成功。使用覆膜支架进行血管内治疗对外周动脉损伤非常有效。在治疗前使用球囊闭塞试验评估侧支血流和中风风险至关重要，尤其是当移植物可能会闭塞椎动脉时。在计划治疗医源性及其他类型的锁骨下动脉损伤时，建议进行球囊闭塞试验。
