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

TL;DR

A minimally invasive endovascular approach is shown to be effective and safe for treating misplaced subclavian artery catheters.

Contribution

A new standardized algorithm using an Angio-Seal™ device is proposed as a minimally invasive alternative to open surgery.

Findings

86.5% primary technical success rate in treating misplaced subclavian artery catheters.

All cases achieved 100% primary assisted technical and clinical success.

Only minor complications occurred, with no need for open surgery.

Abstract

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.

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