Management of Malpositioned Central Venous Catheters in the Subclavian Artery: Case-series and Systematic Review of Literature.

BACKGROUND: Malposition of central venous catheter is a notable technical complication and often need retrieval to avoid further complications. We present a retrospective assessment of case series and literature review of the safety and efficacy of open and endovascular procedures performed to retrieve malpositioned central venous catheters in the subclavian artery.

DATA SOURCES: PubMed/Medline, Ovid and Embase.Case series and review Methods:A retrospective analysis was conducted of the clinical data of seven patients referred to our hospital between 2014 and 2023, in whom malpositioned central venous catheters were incidentally inserted within the subclavian artery and were retrieved. A systematic literature review was undertaken according to PRISMA guidelines to evaluate the efficacy and safety of the reported ways of management. Two investigators independently performed case series and case reports screening in the literature to reveal and evaluate the efficacy of open and endovascular treatment of malpositioned central venous catheterization.

RESULTS: Technical success in safe removal of the misplaced catheter was achieved in all cases. Out of the seven patients, 6 patients (85.7%) were treated endovascularly (four of them (66.6%) treated by ANGIO-SEAL® closure device (Terumo) and two of them (33.3%) were treated with adjunct VIABAHN® covered stent (GORE®), while only one patient was managed by open surgery. All the patients went through uneventful recovery, with mean hospital stay of 3.67 days for the endovascular-treated patients, while the open surgery-treated patient stayed for 12 days. Literature review identified 21 cases of malpositioned central venous catheter, 13 cases were managed by ANGIO-SEAL® closure device (Terumo), three cases were managed by StarClose SE™ (Abbott), two cases were managed by EXOSEAL™ (Cordis), two cases were managed by VIABAHN® ENDOPROTHESIS (GORE®), and one case was treated by open surgical repair. Twenty cases showed no postoperative complications, and only one case showed postoperative pseudoaneurysm which was treated by ultrasound-guided compression.

CONCLUSION: Closure devices, with ANGIO-SEAL (Terumo) being the commonest method, can be safely and effectively utilized for endovascular closure of the subclavian artery following removal of malpositioned central venous catheters. The endovascular options are also accompanied by short hospital stay and lower morbidities. Open surgery should be reserved for patients in whom endovascular options fail.Clinical ImpactThis patient case series and the literature review provided a safe and efficient intervention for treatment of malpositioned central venous catheters in arterial access using Angioseal closure devices, Despite using it out of its IFUs, but it proved to be a proper solution for such complication apart from the known open surgical intervention which accompanied by long hospital stay and morbidity.