A life-saving lesson: Hybrid surgical management of a catastrophic vertebral artery and pleural injury from a misplaced hemodialysis catheter

Abstract

When a neck dialysis catheter is misplaced, it may damage important peripheral blood vessels or nerves, potentially causing severe concomitant injuries. To date, no reported cases or experiences of vertebral artery and pleural injuries caused by dialysis catheter implantation have been documented, nor have the details of emergency open surgery following interventional procedures been thoroughly described. This case report details the management of a 31-year-old male patient with a misplaced dialysis catheter that damaged the vertebral artery and pleura. Despite successful balloon occlusion to prevent bleeding, the patient developed hemorrhagic shock shortly after catheter removal due to the unique nature of the pleural injury. The catheter was ultimately safely removed through a combination of interventional and open surgical procedures. This case underscores the critical importance of standardized catheter placement, highlights the distinct risks and complications associated with dialysis catheter-induced vertebral artery and pleural injuries, and summarizes key considerations and management strategies for such misplaced catheters.