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A PICTURE IS WORTH A THOUSAND WORDS
Year : 2021  |  Volume : 22  |  Issue : 1  |  Page : 76-78  

Rescue angioplasty in subclavian artery after percutaneous closure device failure in an inadvertent misplacement of a central venous line


1 Division of Cardiology, Interventional Cardiology Unit, Joan XXIII University Hospital, IISPV, Rovira I Virgili University, Tarragona, Spain
2 Department of Vascular and Endovascular Surgery, Joan XXIII University Hospital, IISPV, Rovira I Virgili University, Tarragona, Spain
3 Division of Cardiology, Coronary Care Unit, Joan XXIII University Hospital, IISPV, Rovira I Virgili University, Tarragona, Spain

Date of Submission17-May-2020
Date of Acceptance04-Feb-2021
Date of Web Publication22-Apr-2021

Correspondence Address:
Dr. Mohsen Mohandes
Division of Cardiology, Interventional Cardiology Unit, Joan XXIII University Hospital, IISPV, Rovira I Virgili University, Calle Dr Mallafre Guasch 4, 43007 Tarragona
Spain
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/HEARTVIEWS.HEARTVIEWS_83_20

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   Abstract 



How to cite this article:
Mohandes M, Moya BG, Fuertes M, Moreno C, Fernández L, Bonet G, Scardino C. Rescue angioplasty in subclavian artery after percutaneous closure device failure in an inadvertent misplacement of a central venous line. Heart Views 2021;22:76-8

How to cite this URL:
Mohandes M, Moya BG, Fuertes M, Moreno C, Fernández L, Bonet G, Scardino C. Rescue angioplasty in subclavian artery after percutaneous closure device failure in an inadvertent misplacement of a central venous line. Heart Views [serial online] 2021 [cited 2021 Jun 13];22:76-8. Available from: https://www.heartviews.org/text.asp?2021/22/1/76/314404



An 82- year-old man was referred to our centre after an inadvertent misplacement of 8 Fr central venous line (CVL) in subclavian artery (SA) [Figure 1]. We planned percutaneous closure of the SA with ProGlide® Suture-Mediated Closure System (Abbott Vascular) after ruling out an arteriovenous fistula by CT scan. We proceeded with percutaneous closure while a wire was kept in the SA in anticipation of needing balloon inflation in case of device failure. However, the ProGlide became stuck in the SA and after many difficulties, it could be externalised and rupture of ProGlide's foot was verified [Figure 2]. While a vigorous manual compression was exerted, a covered stent (Viabahn 8x50 mm Gore®) via femoral artery was immediately implanted in the SA with complete sealing of punctured site although thrombus formation was observed distally [Figure 3].
Figure 1: Angiography of the Subclavian artery. The arrow shows the entrance point of the central venous line

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Figure 2: ProGlide is being deformed and stuck in subclavian artery (left). Complete fracture of a ProGlide's foot was seen once it was externalized (right)

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Figure 3: Viabahn 8 mm × 50 mm is being implanted in the subclavian artery while a vigorous manual compression is exerted (left). Angiographic control shows the absence of extravasation at the site of the puncture and patency of the vertebral artery, although thrombus formation was seen in subclavian artery mid-segment (right arrow)

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A second Viabahn (8x100 mm) was overlapped with the previous one and implanted in the subclavian-axillar artery with excellent result [Figure 4].
Figure 4: A second covered stent (Viabahn 8 mm × 100 mm) was implanted overlapped with the previous one (left). Final angiography shows good final result (right)

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Misplacement of CVL is a rare complication and occurs in approximately 2.7% of subclavian approaches.[1] It can potentially be a serious complication since its withdrawal can be followed by significant bleeding since hemostasis by manual compression is not easy. Percutaneous closure of the orifice with simultaneous balloon inflation in the SA has been previously described as an adequate option.[2] In our case, the rupture of the closure device was caused as the orifice site probably forced excessive device angulation. Covered stent implantation sealed the puncture site without any residual extravasation.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Eisen LA, Narasimhan M, Berger JS, Mayo PH, Rosen MJ, Schneider RF. Mechanical complications of central venous catheters. J Intensive Care Med. 2006; 21:40-46.  Back to cited text no. 1
    
2.
Park TK, Yang JH, Choi SH. Endovascular Repair Using Suture-Mediated Closure Devices and Balloon Tamponade following Inadvertent Subclavian Artery Catheterization with Large-Caliber Hemodialysis Catheter. Korean Circ J. 2016; 46: 584-587.  Back to cited text no. 2
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

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