• SCVS Home
• President's Message
• Council
• Commitees
• Annual Meeting
• 37th Annual Symposium
• 36th Annual Symposium
• 35th Annual Symposium
• 34th Annual Symposium
• 33rd Annual Symposium
• Membership
• Join SCVS
• Members Only Area
• Find a Vascular Specialist
• Newsletters
• Journal
• History
• Mission Statement
• Bylaws
• Contact Us
• 37th Annual Symposium
• 36th Annual Symposium
• 35th Annual Symposium
• 34th Annual Symposium
• 33rd Annual Symposium
• Join SCVS
• Members Only Area
• Find a Vascular Specialist

Experience and Technique for the Endovascular Management of Iatrogenic Subclavian Artery Injury

OBJECTIVES: Inadvertent subclavian artery catheterization during attempted central venous access is a well known complication. The subclavian artery is difficult to compress under the clavicle and historically, these patients are managed with an open operative approach and repair under direct vision via an infraclavicular and/or supraclavicular incision. We describe our experience and technique for endovascular management of these injuries.
METHODS: Sixteen patients were identified with inadvertent iatrogenic subclavian artery cannulation (8 triple lumen catheters and 8 swan introducers). All cases were managed via an endovascular technique and performed under local anesthesia in the operating room. After correcting any coagulopathy, a 4 French glide catheter was percutaneously inserted into the ipsilateral brachial artery and placed in the proximal subclavian artery. Following an arteriogram and localization of the subclavian arterial insertion site, the subclavian catheter was removed and bimanual compression was performed on both sides of the clavicle around the puncture site for 20 minutes. A second angiogram was performed and if there was any extravasation, pressure was held for an additional 20 minutes. Another angiogram was performed, and if hemostasis was not obtained, a stent graft was placed via the brachial access site to repair the arterial defect and control the bleeding. Pressure was held over the brachial artery puncture site.
RESULTS: Two of the 16 patients required a stent graft for continued bleeding after compression. Both patients were well excluded after endovascular graft placement. Hemostasis was successfully obtained with bimanual compression over the puncture site in the remaining 14 patients. There were no resultant complications at either the subclavian or brachial puncture sites.
CONCLUSIONS: This minimally invasive endovascular approach to iatrogenic subclavian artery line placement is a safe alternative to blind removal with manual compression or direct open repair.