Clinical Management and Literature Review of Iatrogenic Vertebral Artery Injury During Internal Jugular Vein Catheterization: Diagnostic Strategies, Endovascular Intervention, and Multidisciplinary Care.

BACKGROUND

Catheterization of the internal jugular vein (IJV) is frequently performed for central venous access but may result in serious complications, including vertebral artery injury. This report presents a case of vertebral artery injury secondary to IJV catheterization and includes a systematic review of the relevant literature.

CASE REPORT: A 65-year-old female patient scheduled for a Whipple procedure due to a duodenal ampullary mass, experienced difficulty during right IJV catheterization performed without ultrasound guidance. Postoperatively, the patient developed hypotension, neck swelling, and an acute decrease in hemoglobin levels. Imaging confirmed a right vertebral artery-IJV arteriovenous fistula, which was successfully treated with endovascular coil embolization. Full recovery was achieved after multidisciplinary care, without any neurological complications.

LITERATURE REVIEW: A systematic review of 47 reported cases of IJV catheterization-related vertebral artery injury was conducted, summarizing injury mechanisms, clinical manifestations, diagnostic approaches, and management strategies. Iatrogenic vertebral artery injury occurred most frequently during catheterization performed without ultrasound guidance (78.7%), with common presentations including neck swelling (63.8%) and hemodynamic instability (51.1%). Endovascular therapy represented the predominant treatment approach (89.4%), with coil embolization being the most frequently used technique (61.7%).

CONCLUSIONS

Although rare, vertebral artery injury after IJV catheterization can result in significant morbidity. The use of ultrasound guidance significantly reduces procedural risk, whereas prompt diagnosis and timely endovascular intervention are critical to achieving favorable clinical outcomes. Effective management requires coordinated multidisciplinary involvement.