Misplaced central line piercing common carotid removed and stented through a multidisciplinary approach: A video description

Abstract

Central venous catheterizations, or central lines, are commonly placed in critical care situations for vasopressor support and resuscitation. However, central line placement still carries a 3% risk of major complications. ¹ While rare, inadvertent placement of large-bore central venous lines into the carotid arteries can be seen in 0.1% to 0.5% of cases. ² Utilizing a minimally invasive technique, such as a stent graft, to quickly seal the pierced artery after removal should be considered in cases needing vascular repair. We present the case of a 54-year-old female who was admitted to the intensive care unit for management of septic shock. At an outside hospital, her systolic blood pressure was 60 mmHg. She had a subclavian vein central line misplaced—inadvertently piercing the left common carotid, passing through the aortic valve, and terminating in the left ventricle. After a multidisciplinary discussion, the vascular surgery team felt surgery to be too high-risk. The patient was taken to a hybrid interventional suite with neurointerventional radiology and cardiothoracic surgery, where she underwent stenting of the left common carotid with a covered stent graft and simultaneous removal of the misplaced central line under fluoroscopy. The patient had excellent flow through the carotid stents with repeat computed tomography angiography head and neck imaging post-procedure and after three months. This case highlights the importance of considering endovascular management for iatrogenic vascular events in cases where surgical access is challenging or in critical conditions where there are increased risks of complications.