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. Apr-Jun 2016;26(2):262-6.
doi: 10.4103/0971-3026.184425.

Percutaneous Repair of Iatrogenic Subclavian Artery Injury by Suture-Mediated Closure Device

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Free PMC article

Percutaneous Repair of Iatrogenic Subclavian Artery Injury by Suture-Mediated Closure Device

Rahul S Chivate et al. Indian J Radiol Imaging. .
Free PMC article

Abstract

Central venous catheterization through internal jugular vein is done routinely in intensive care units. It is generally safe, more so when the procedure is performed under ultrasound guidance. However, there could be inadvertent puncture of other vessels in the neck when the procedure is not performed under real-time sonographic guidance. Closure of this vessel opening can pose a challenge if it is an artery, in a location difficult to compress, and is further complicated by deranged coagulation profile. Here, we discuss the removal of an inadvertently placed catheter from subclavian artery with closure of arteriotomy percutaneously using arterial suture-mediated closure device.

Keywords: Inadvertent puncture; percutaneous suture device; subclavian artery.

Figures

Figure 1
Figure 1
Computed tomography angiography with coronal reconstructed image shows placement of catheter tip in subclavian artery. Ao - Aorta, C- Catheter
Figure 2
Figure 2
Digital subtraction angiography image of contrast injected through catheter confirms its tip in subclavian artery. C - Catheter, SA - Subclavian artery, VA - Vertebral artery, Ao - Aorta, TC - Thyrocervical trunk, *Left internal mammary artery
Figure 3
Figure 3
Subclavian artery angiography performed using H1 catheter shows subtracted catheter tip between vertebral artery and internal mammary artery. Small suspicious filling defect seen at the puncture site (arrow). SA - Subclavian artery, VA - Vertebral artery, TC - Thyrocervical trunk, LIMA - Left internal mammary artery, H1 - Head hunter catheter H1 4Fr
Figure 4 (A and B)
Figure 4 (A and B)
(A) 6 Fr. Perclose ProGlide Suture Mediated Closure System (Abbott); (B) Radiographic image of device (D) over wire
Figure 5
Figure 5
Perclose device removed and knot tightened with the help of knot tightner. Wire still kept in situ. W - 0.035” Amplatz stiff wire, K - Knot tightner
Figure 6
Figure 6
Subclavian artery angiogram shows no extravasation of contrast. Small filling defect (arrow) seen close to puncture site could be thrombus or dissection flap. SA - Subclavian artery, VA - Vertebral artery, TC - Thyrocervical trunk, LIMA - Left internal mammary artery, K - Knot tightener
Figure 7
Figure 7
Postprocedure reformatted image of computed tomography angiography shows patent left subclavian artery. No thrombus or dissection flap seen. VA - Vertebral artery

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