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Misplaced central venous catheter in the vertebral artery: endovascular treatment of foreseen hemorrhage during catheter withdrawal.
[familial mediterranean fever]
We
report
on
the
endovascular
management
of
hemorrhage
with
stent-graft
due
to
a
misplaced
central
venous
catheter
in
the
vertebral
artery
(
VA
)
during
percutaneous
internal
jugular
vein
catheterization
in
a
child
.
A
16
-
year
-old
female
was
presented
with
the
diagnosis
of
familial
Mediterranean
fever
related
chronic
renal
insufficiency
.
An
attempt
was
made
to
place
a
central
venous
catheter
via
the
right
internal
jugular
vein
without
image
guidance
and
the
patient
experienced
dyspnea
and
pain
at
the
catheter
insertion
site
.
Computerized
tomography
(
CT
)
showed
hemorrhage
in
the
cervical
region
and
upper
mediastinum
,
also
reformatted
images
showed
that
the
catheter
was
passing
through
the
proximal
part
of
the
VA
and
terminating
in
the
right
mediastinum
.
The
catheter
was
removed
during
manual
compression
under
angio-flouroscopic
monitoring
and
ongoing
extravasation
was
observed
.
A
stent-graft
was
placed
to
the
bleeding
site
of
the
VA
.
Angiography
immediately
after
the
stent-graft
placement
revealed
complete
disappearance
of
extravasation
and
patency
of
vertebral
and
subclavian
arteries
.
Central
venous
catheterization
(
CVC
)
is
not
a
risk-free
procedure
and
arterial
injuries
are
in
a
wide
spectrum
from
a
simple
puncture
to
rupture
of
the
artery
.
Inadvertent
VA
cannulation
is
a
rare
and
serious
complication
necessitating
prompt
diagnosis
and
early
treatment
.
If
an
arterial
injury
with
a
large
-caliber
catheter
occurs
,
endovascular
treatment
with
stent-graft
seems
to
be
a
safe
and
effective
option
in
terms
of
achieving
hemostasis
and
preserving
arterial
patency
.
Recent
findings
suggest
that
endovascular
management
of
inadvertent
cervical
arterial
injury
secondary
to
CVC
seems
to
be
the
safest
strategy
.
Diseases
Validation
Diseases presenting
"arterial patency"
symptom
familial mediterranean fever
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