REGULAR CONTENT
Final ID
585
Type
Educational Exhibit-Poster Only
Authors
J Koo1, A Mohandas1, J Kallini1, G Elias2, J Tisnado2
Institutions
1Wayne State University School of Medicine / Detroit Medical Center, Detroit, MI, 2Virginia Commonwealth University, Richmond, VA
Purpose
To review radiologic diagnosis and IR management of iatrogenic arterial injuries and catheterization during attempted central venous catheter placement.
Materials & Methods
Central venous catheter placement (CVCP) is a common procedure in many clinical settings for a variety of indications. More than 5 million central venous catheters are inserted annually in the United States and are frequently delegated to the least experienced personnel. Therefore, many instances of unintentional puncture and catheterization of arteries have occurred. It's incidence ranges from 1-15%Inadvertent arterial puncture is often without consequence. However, it can lead to catastrophic consequences- hemorrhage, thromboembolism causing major stroke, arteriovenous fistula and pseudoaneurysm, especially with large bore dilation or catherization. Therefore, early recognition and prompt endovascular management is critical.
Results
Imaging appearance of arterial injuries and inadvertent placement of the CVC in the arteries: carotid, innominate, subclavian, and brachial, are reviewed.Interventional radiologic (IR) management via endovascular approach include- placement of stents of different types with and without embolization of bleeding sites or tract. Evidence based review for selecting from various types of stents- covered, uncovered, self-expanding or balloon-expandable is investigated.Technical details of removing the catheters inadvertently placed in the arteries are depicted. The outcome of the procedures is reviewed.
Conclusions
Inadvertent insertion of central venous catheters in the arteries is an uncommon complication of CVCP, but is increasing in frequency in this era of aggressive medical care and lack of expertise of the operators. IR has a critical role in managing these complications using different tricks-of-the-trade: stenting with and without embolization.
Final ID
585
Type
Educational Exhibit-Poster Only
Authors
J Koo1, A Mohandas1, J Kallini1, G Elias2, J Tisnado2
Institutions
1Wayne State University School of Medicine / Detroit Medical Center, Detroit, MI, 2Virginia Commonwealth University, Richmond, VA
Purpose
To review radiologic diagnosis and IR management of iatrogenic arterial injuries and catheterization during attempted central venous catheter placement.
Materials & Methods
Central venous catheter placement (CVCP) is a common procedure in many clinical settings for a variety of indications. More than 5 million central venous catheters are inserted annually in the United States and are frequently delegated to the least experienced personnel. Therefore, many instances of unintentional puncture and catheterization of arteries have occurred. It's incidence ranges from 1-15%Inadvertent arterial puncture is often without consequence. However, it can lead to catastrophic consequences- hemorrhage, thromboembolism causing major stroke, arteriovenous fistula and pseudoaneurysm, especially with large bore dilation or catherization. Therefore, early recognition and prompt endovascular management is critical.
Results
Imaging appearance of arterial injuries and inadvertent placement of the CVC in the arteries: carotid, innominate, subclavian, and brachial, are reviewed.Interventional radiologic (IR) management via endovascular approach include- placement of stents of different types with and without embolization of bleeding sites or tract. Evidence based review for selecting from various types of stents- covered, uncovered, self-expanding or balloon-expandable is investigated.Technical details of removing the catheters inadvertently placed in the arteries are depicted. The outcome of the procedures is reviewed.
Conclusions
Inadvertent insertion of central venous catheters in the arteries is an uncommon complication of CVCP, but is increasing in frequency in this era of aggressive medical care and lack of expertise of the operators. IR has a critical role in managing these complications using different tricks-of-the-trade: stenting with and without embolization.