Percutaneous Closure of a Large-Bore Carotid Arteriotomy Using a Collagen-Based Vascular Plug

TL;DR

A collagen-based device successfully closed a large carotid artery opening during emergency surgery, avoiding the need for open surgery.

Contribution

Demonstrates the feasibility of using a collagen-based vascular plug for large-bore carotid arteriotomies in acute surgical settings.

Findings

Percutaneous closure with an 18-French MANTA device achieved immediate hemostasis in a large carotid arteriotomy.

The patient remained neurologically intact with no complications during a 12-month follow-up.

Imaging confirmed carotid artery patency and absence of stenosis or pseudoaneurysm formation.

Abstract

Background: Inadvertent arterial cannulation during central venous catheter placement is a recognized complication with potentially serious consequences, particularly when involving large-caliber catheters. While management strategies have evolved from mandatory surgical repair to various percutaneous approaches, limited data exist regarding collagen-based vascular closure devices for large-bore carotid arteriotomies. Case Presentation: We report the case of a 59-year-old male patient with acute Stanford Type A aortic dissection who underwent emergency surgical repair of the ascending aorta. During central venous cannulation, a five-lumen Certofix Quinto catheter (12-French outer diameter) was inadvertently inserted into the left common carotid artery. Given the complexity of concurrent cardiac surgery and the large-bore nature of the arteriotomy, percutaneous closure with an 18-French MANTA vascular closure device was successfully performed following completion of the aortic repair. The procedure achieved immediate hemostasis without complications. Outcomes: The patient remained neurologically intact throughout a 12-month follow-up period. Serial duplex ultrasonography and computed tomography angiography confirmed carotid artery patency without evidence of stenosis, dissection, pseudoaneurysm formation, or thromboembolic complications. Conclusions: This case demonstrates the technical feasibility of using a collagen-based vascular closure device for percutaneous management of a large-bore carotid arteriotomy in the acute surgical setting. While the outcome was favorable in this patient, this approach represents an off-label application that requires further validation and should be reserved for carefully selected cases in experienced centers where the benefits of percutaneous closure are judged to outweigh the uncertainties of supra-aortic device deployment.

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