Endovascular management of inadvertent subclavian artery catheterization during subclavian vein cannulation. 2010

Andreas P Chemelli, and Franz Wiedermann, and Josef Klocker, and Juergen Falkensammer, and Alexander Strasak, and Benedikt V Czermak, and Peter Waldenberger, and Iris E Chemelli-Steinguber
Department of Radiology, Innsbruck Medical University, 6020 Innsbruck, Austria.

OBJECTIVE To retrospectively review a 9-year experience with endovascular management of inadvertent subclavian artery catheterization during subclavian vein cannulation. METHODS From June 2000 through July 2009 (109 months), 13 patients underwent endovascular management of inadvertent subclavian artery catheterization. All catheters were still in situ, including one 7-F catheter, six 8-F catheters, and six large-bore 10-11-F catheters. Treatment was performed with an Angio-Seal device (n = 6) or balloon catheters (n = 7) and by additional stent-graft placement (n = 4). RESULTS Mean follow-up was 27.3 months (range, 0.4-78 months). The 30-day mortality rate was 7.7% and the late mortality rate was 46.1%. Primary technical success was achieved in nine patients (69.2%), in four with the use of a compliant balloon catheter and in the other five with an Angio-Seal device. Complications required additional stent-graft placement in four patients (30.8%), one because of stenosis after Angio-Seal device deployment and three as a result of insufficient closure of the puncture site by balloon tamponade. Stent-graft repair was successful in all four patients, for a primary assisted technical success rate of 100%. CONCLUSIONS Endovascular techniques offer a less invasive alternative to surgery. The present limited experience shows that the use of the Angio-Seal device is not without risks, whereas balloon tamponade is not always reliable in closing the puncture site. Stent-graft placement may be required in patients in whom balloon tamponade fails or in whom the use of the Angio-Seal device is contraindicated.

UI MeSH Term Description Entries
D008297 Male Males
D008875 Middle Aged An adult aged 45 - 64 years. Middle Age
D002404 Catheterization Use or insertion of a tubular device into a duct, blood vessel, hollow organ, or body cavity for injecting or withdrawing fluids for diagnostic or therapeutic purposes. It differs from INTUBATION in that the tube here is used to restore or maintain patency in obstructions. Cannulation,Cannulations,Catheterizations
D005260 Female Females
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000368 Aged A person 65 years of age or older. For a person older than 79 years, AGED, 80 AND OVER is available. Elderly
D000369 Aged, 80 and over Persons 80 years of age and older. Oldest Old
D013348 Subclavian Artery Artery arising from the brachiocephalic trunk on the right side and from the arch of the aorta on the left side. It distributes to the neck, thoracic wall, spinal cord, brain, meninges, and upper limb. Arteries, Subclavian,Artery, Subclavian,Subclavian Arteries
D013349 Subclavian Steal Syndrome A clinically significant reduction in blood supply to the BRAIN STEM and CEREBELLUM (i.e., VERTEBROBASILAR INSUFFICIENCY) resulting from reversal of blood flow through the VERTEBRAL ARTERY from occlusion or stenosis of the proximal subclavian or brachiocephalic artery. Common symptoms include VERTIGO; SYNCOPE; and INTERMITTENT CLAUDICATION of the involved upper extremity. Subclavian steal may also occur in asymptomatic individuals. (From J Cardiovasc Surg 1994;35(1):11-4; Acta Neurol Scand 1994;90(3):174-8) Basilar Steal Syndrome,Brachial-Basilar Insufficiency Syndrome,Subclavian Artery Stenosis,Subclavian Steal,Subclavian Steal Phenomenon,Subclavian-Carotid Artery Steal Syndrome,Artery Stenoses, Subclavian,Artery Stenosis, Subclavian,Basilar Steal Syndromes,Brachial Basilar Insufficiency Syndrome,Brachial-Basilar Insufficiency Syndromes,Insufficiency Syndrome, Brachial-Basilar,Insufficiency Syndromes, Brachial-Basilar,Phenomenon, Subclavian Steal,Steal Phenomenon, Subclavian,Steal Syndrome, Basilar,Steal Syndrome, Subclavian,Steal Syndromes, Basilar,Steal Syndromes, Subclavian,Steal, Subclavian,Stenoses, Subclavian Artery,Stenosis, Subclavian Artery,Subclavian Artery Stenoses,Subclavian Carotid Artery Steal Syndrome,Subclavian Steal Syndromes,Syndrome, Brachial-Basilar Insufficiency,Syndromes, Brachial-Basilar Insufficiency
D016896 Treatment Outcome Evaluation undertaken to assess the results or consequences of management and procedures used in combating disease in order to determine the efficacy, effectiveness, safety, and practicability of these interventions in individual cases or series. Rehabilitation Outcome,Treatment Effectiveness,Clinical Effectiveness,Clinical Efficacy,Patient-Relevant Outcome,Treatment Efficacy,Effectiveness, Clinical,Effectiveness, Treatment,Efficacy, Clinical,Efficacy, Treatment,Outcome, Patient-Relevant,Outcome, Rehabilitation,Outcome, Treatment,Outcomes, Patient-Relevant,Patient Relevant Outcome,Patient-Relevant Outcomes

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