Iatrogenic vertebral artery injury during central line placement: a case report

TL;DR

A rare case of vertebral artery injury during central line placement in a critically ill patient is reported, emphasizing the need for careful technique and timely intervention.

Contribution

This case report adds to the clinical understanding of rare but severe complications during central venous catheterization.

Findings

Computed tomography angiography confirmed a left vertebral artery injury during central line placement.

Endovascular repair with a covered stent via brachial access successfully controlled bleeding and stabilized the patient.

The case underscores the importance of advanced imaging and vascular consultation in managing arterial injuries.

Abstract

Central venous catheterization is commonly performed in critically ill patients but carries risks, including arterial injury. Vertebral artery injury during central venous catheterization insertion is rare but can cause severe morbidity and mortality if not promptly recognized and managed. Early diagnosis and intervention are crucial to minimizing complications. A 55-year-old Arab male of Middle Eastern ethnicity with severe community-acquired pneumonia required intubation and vasopressor support. During an attempt to insert a central venous catheterization through the left internal jugular vein, the patient developed acute hypotension and a significant hemoglobin drop, indicating active bleeding. Computed tomography angiography confirmed a left vertebral artery injury. Endovascular repair with a covered balloon-expandable stent via brachial access led to immediate hemodynamic stabilization and bleeding control. This case highlights the importance of meticulous technique, monitoring, and advanced imaging. Vascular surgery consultation and imaging guide management. Endovascular procedures offer safer, less invasive options when performed by experienced interventionists.

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