Management of Inadvertent Carotid Artery Sheath Insertion during Jugular Venous Cannulation for Pulmonary Artery Catheter Placement: A Comparison of Operative and Endovascular Treatment.

Introduction: Inadvertent arterial sheath insertion during central venous catheter placement is a potentially serious complication. In this study, we report our management in patients who received an inadvertent carotid artery sheath insertion intraoperatively during attempted jugular venous cannulation for pulmonary artery catheter placement.
Methods: During a 9 year period, a total of 11 patients were identified who sustained intraoperative carotid artery introducer sheath placement during attempted jugular vein cannulation. Six patients underwent immediate carotid exploration with operative sheath removal while five patients underwent percutanous carotid closure using endovascular suture device. Treatment outcome of these two groups were analyzed.
Results: Technical success was achieved in all patients in both groups. The intended operations were aborted in all patients following catheter removal and carotid artery closure. The mean durations of treatment modality of operative and endovascular groups were 30±12 minutes and 6±3 minutes (p<0.03), respectively. No neurological deficit occurred in either group. The intended operations were all subsequently performed, and the mean delay of operation in operative and endovascular groups were 5±2 days and 3±1 days (NS). Follow-up carotid duplex showed no injury of the repaired artery in either group. During mean follow-up of 36 months, no complication or neurological deficit were noted in either patient cohort.
Conclusion: Inadvertent carotid artery sheath placement during attempted central venous cannulation for pulmonary artery catheter insertion mandates catheter removal and repair of the carotid artery punctured site. Application of an endovascular closure device permits percutanous repair of the carotid artery expeditiously. Our experience showed this treatment modality is as safe and efficacious when compared to operative repair.