Rescue Procedure in a Rare Case of Iatrogenic Vertebral Artery Puncture and Review of the Literature

TL;DR

This paper describes a rare case where a catheter accidentally punctured an artery and was successfully treated using a stent, along with a review of similar cases in medical literature.

Contribution

The paper presents a novel case of successful endovascular stent graft treatment for iatrogenic vertebral artery puncture and summarizes existing literature on this rare complication.

Findings

Endovascular stent graft placement was successful in treating iatrogenic vertebral artery puncture without significant bleeding.

Literature review shows endovascular treatment is consistently effective for catheter-related arterial injuries.

Primary stent graft placement is the most common and successful treatment approach reported.

Abstract

Objective: The insertion of venous catheters into supra-aortic vessels is a standard procedure in the treatment of a large number of diseases. Incorrect placement of venous catheters into and accidental perforation of arterial vessels is a rare but serious complication that can lead to severe bleeding, dissections, and strokes. Materials and Methods: We present a case of iatrogenic malposition of a Broviac catheter into the right vertebral artery and its successful treatment through stenting of the perforation site using a Walrus balloon catheter to achieve a secure treatment position and eventually cover the perforation site. Additionally, we conducted a systematic literature review on endovascular rescue procedures in inadvertent injuries of the supra-aortic arteries related to venous catheter placement. Results: A balloon guide catheter was used to achieve a secure treatment position for the deployment of a stent graft covering the perforation site, ensuring no significant arterial hemorrhage occurred during the removal of the incorrectly placed Broviac catheter. The review of the literature on endovascular rescue procedures for supra-aortic arterial vessel damage caused by venous catheter placement revealed that endovascular treatment has been successful in all reported cases of catheter-related supra-aortic arterial injury. Primary stent graft placement without additional actions was the most common treatment approach. Conclusions: In the treatment of iatrogenic injuries to the supra-aortic vessels, endovascular treatment strategies represent a safe, reliable, and generally recognized option and thus are used much more frequently than surgical procedures. Key point: In rare cases of accidental malposition of venous catheters into supra-aortic arterial vessels, endovascular insertion of a stent graft covering the perforation site using a balloon guide catheter can be a safe treatment option.

Figures