CC BY-NC-ND 4.0 · The Arab Journal of Interventional Radiology 2018; 02(03): S14
DOI: 10.1055/s-0041-1730683
Abstract

Management of Arterial Injuries Related to Central Venous Access: A Single Institution Experience

Abdullah Ayesh Al-Mutairi
King Saud Bin Abdulaziz for Health Science University, Riyadh, Saudi Arabia
,
Mohammad Arabi
King Saud Bin Abdulaziz for Health Science University, Riyadh, Saudi Arabia
,
Abdulaziz Abdullah Alangari
King Saud Bin Abdulaziz for Health Science University, Riyadh, Saudi Arabia
,
Mohammad Mari Alamri
King Saud Bin Abdulaziz for Health Science University, Riyadh, Saudi Arabia
,
Abdulaziz Alharbi
King Saud Bin Abdulaziz for Health Science University, Riyadh, Saudi Arabia
,
Yousof Alzahrani
King Saud Bin Abdulaziz for Health Science University, Riyadh, Saudi Arabia
› Author Affiliations

Background: Retrospectively identify the types of arterial injuries related to central venous access and management techniques with long-term outcomes. Methods: Between January 2007 and November 2017, a total of 20 patients (13 females) were included with a mean age of 63 (28–89 years) and mean body mass index of 25.75 (13.3–36.5). Venous access procedures included central venous catheter (CVC) placement, dialysis line insertion, or endovascular venous procedures. The study excluded patients who had arterial injuries related to arterial access, such as postarterial line placement, postangiography, or percutaneous coronary interventions. Results: Iatrogenic arterial injuries occurred after attempted venous access procedures into the common femoral vein (n = 18) and subclavian vein (n = 2). Injuries were related to CVC placement (n = 5), temporary dialysis catheter (n = 14), and inferior vena cava filter insertion (n = 1). Nine patients had transarterial venous catheter insertion complicated by active bleeding from pseudoaneurysm and arteriovenous fistula. Other injuries included isolated fistula (n = 3), isolated pseudoaneurysm (n = 4), isolated branch injury (n = 2), and intra-arterial insertion (n = 2). Endovascular management was done with stent-graft placement (n = 14), embolization of bleeding vessel (n = 2), thrombin injection for pseudoaneurysm (n = 2), or by compression/conservative management (n = 2). Technical success was achieved in 100%. One patient required repeat angiography and embolization of isolated branch following stent-graft placement to control bleeding fistula and pseudoaneurysm. Clinical success was achieved in all patients. Procedure-related complications included puncture site hematoma (n = 1), partially occlusive thrombus/spasm of the deep femoral artery after stent graft placement. Six patients (33%) died in <30 days after the procedure (3–20 days) from other comorbidities. Three additional patients (16%) died during the same admission of the procedure (38–114 days). In 7 out of 14 patients, who survived after stent-graft placement, there were no reported complaints related to possible stent stenosis or occlusion at mean follow-up time of 5 years (50 days–8.64 years). Conclusion: Despite technically successful endovascular management of arterial injuries related to venous access in critically ill patients, mortality rate remains high due to other comorbidities. Allowing for the small sample size, stent-graft placement for arterial injuries in this cohort of patients appears to be an effective option with high long-term patency rate.



Publication History

Article published online:
11 May 2021

© 2018. The Arab Journal of Interventional Radiology. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

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