Page 8 - Virtual Vascular Vol 8

Iatrogenic Carotid and Subclavian Puncture

he internal jugular vein is often the target for central venous access, including hemodial-
Tysis, monitoring, and chemotherapy. Percutaneous puncture is increasingly used by in-
tensivists, anesthesiologists, and other physicians. Even with ultrasound guidance, accidental
puncture of the common carotid artery is possible, and if not recognized, placement of a large
bore catheter into the carotid artery (and its removal without proper caution) can lead to
disastrous consequences. We are seeing an increasing trend of carotid artery injuries in the
past few months.

A 71 year old man with a hemodialysis catheter placed in the right common carotid artery in a hos- A 62 year old man with CA liver received a percutaneous large bore central venous line which had

pital in Kowloon. He died shortly after simple removal and failed compression, likely due to hemo- accidentally entered the right subclavian artery. An attempted endovascular repair with a clo-
mediastinum. sure device was performed (in a hospital in Kowloon), probably unsuccessful, and the patient died
shortly afterwards.

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