Right subclavian artery injury during catheter insertion into the right internal jugular vein treated with endovascular stent graft placement after balloon occlusion test: A case report

Yuto Tamaoki; Ryo Kamidani; Hideshi Okada; Takahito Miyake; Kodai Suzuki; Takahiro Yoshida; Keisuke Kumada; Shozo Yoshida; Shinji Ogura

doi:10.1016/j.radcr.2024.03.025

Right subclavian artery injury during catheter insertion into the right internal jugular vein treated with endovascular stent graft placement after balloon occlusion test: A case report

Radiol Case Rep. 2024 Apr 13;19(7):2579-2584. doi: 10.1016/j.radcr.2024.03.025. eCollection 2024 Jul.

Authors

Yuto Tamaoki¹, Ryo Kamidani¹, Hideshi Okada¹, Takahito Miyake¹, Kodai Suzuki¹, Takahiro Yoshida¹, Keisuke Kumada^{1

2}, Shozo Yoshida^{1

3}, Shinji Ogura¹

Affiliations

¹ Advanced Critical Care Center, Gifu University Hospital, 1-1, Yanagido, Gifu city, Gifu 501-1194, Japan.
² Patient Safety Division, Gifu University Hospital, 1-1, Yanagido, Gifu city, Gifu 501-1194, Japan.
³ Abuse Prevention Center, Gifu University Graduate School of Medicine, 1-1, Yanagido, Gifu city, Gifu 501-1194, Japan.

Abstract

Subclavian artery injuries during internal jugular vein puncture when attempting central venous catheter insertion are rare. A 60-year-old man undergoing treatment for neuromyelitis optica with paralysis and sensory loss developed a complication during catheter placement into his right internal jugular vein for plasmapheresis. His previous physician felt resistance and discontinued the procedure. The patient later developed mild dyspnea and dysphagia. Computed tomography scans indicated thrombus formation and tracheal deviation. Contrast-enhanced computed tomography scans showed right subclavian artery injury with extravasation and a large pseudoaneurysm. Following transferal to our hospital, he was stable and asymptomatic; however, contrast-enhanced computed tomography scans showed a pseudoaneurysm located proximal to the right subclavian artery. Considering challenges with compression hemostasis and the invasiveness of open surgery, endovascular treatment was selected using a VIABAHN stent graft. A balloon occlusion test of the right vertebral artery was performed to assess stroke risk. Prophylactic embolization of the right vertebral artery, internal thoracic artery, and thyrocervical trunk were performed to prevent a type 2 endoleak. On hospital day 5, our patient showed no postoperative complications and was transferred to the referring hospital. Follow-up imaging showed the graft was intact with no pseudoaneurysm, confirming successful treatment. Endovascular treatment with a stent graft is highly effective for peripheral artery injuries. Using a balloon occlusion test to assess collateral blood flow and stroke risk is essential pretreatment, especially when a graft might occlude the vertebral artery. Balloon occlusion tests are recommended when planning treatment for iatrogenic and other types of subclavian artery injuries.

Keywords: Balloon occlusion test; Central venous catheter; Cerebral infarction; Complication; Subclavian artery injury; VIABAHN stent-graft.

Publication types

Case Reports