Minimally Invasive Management of Subclavian Artery Catheter Misplacement: The New Standard?

Background

The accidental puncture of the supra-aortal arteries during central venous catheterization is a rare but potentially life-threatening complication. Traditional management often requires open surgical repair, which is associated with significant morbidity. This study evaluates an endovascular approach for managing such cases using an Angio-Seal™ vascular closure device (Terumo Medical Corporation, Somerset, NJ, USA).

Methods

Between January 2010 and December 2024, 47 patients with misplaced catheters in supra-aortal arteries were treated at our institution. Of these, 37 cases involving subclavian artery catheter misplacements were managed using a standardized algorithm and form the focus of this study. Additional interventions, such as stent graft placement or balloon inflation, were performed as needed.

Results

Primary technical success was achieved in 86.5% of cases. Four patients required stentgrafts and one balloon inflation for persistent extravasations. One patient developed a small subclavian pseudoaneurysm, which resolved spontaneously. Primary assisted technical success and clinical success rates were both 100%.

Conclusions

This study demonstrates the efficacy and safety of our minimally invasive endovascular approach for managing subclavian artery catheter misplacements. With a high success rate, low complication rate, and the avoidance of open surgery, this algorithm offers a promising alternative for treating this rare but serious complication of central venous catheterization.