An iatrogenic complication of internal jugular vein catheterization for hemodialysis

Iatrogenic cervical arterio-venous fistula

Arteriovenous fistula (AVF) are the preferred hemodialysis vascular access. However, central venous catheter (CVC) placement rates remain very high in patients initiating hemodialysis and/or in whom with a fistula dysfunction. Several complications are associated with the insertion of these catheters, including infection, thrombosis and arterial injuries. Iatrogenic AVF are uncommon complications. Herein, we report the case of a 53-year-old female with an iatrogenic right subclavian artery - internal jugular vein fistula secondary to a right internal jugular catheter malposition. Through a median sternotomy combined with supraclavicular approach, AVF exclusion with direct suture of subclavian artery and the internal jugular vein was performed. The patient was discharged without any complications.

[Iatrogenic carotid-jugular arterio-venous fistula: a rare complication associated with jugular venous catheterization (a case report)]

Le cathétérisme de la veine jugulaire interne est pratiqué largement, aussi bien par les néphrologues que par les chirurgiens, il est devenu une procédure de routine, mais qui peut être associée à de graves complications. La fistule artério-veineuse carotido-jugulaire (FCJ) est une complication rare mais potentiellement fatale. Très peu de cas sont rapportés dans la littérature. Nous présentons un cas unique d´un patient avec une FCJ iatrogène, suite à une pose de cathéter d'hémodialyse trois semaines auparavant. Le diagnostic est suspecté cliniquement par la découverte de thrill latéro-cervical, et confirmé à l´écho-Doppler et à l´angiographie. Le patient a eu une cure chirurgicale ouverte avec succès. L'expérience de l´opérateur et l´accompagnement des jeunes internes, en plus de l'utilisation du guidage échographique peut réduire considérablement la survenue de complications lors du cathétérisme veineux jugulaire.

A systematic review of management of inadvertent arterial injury during central venous catheterisation

INTRODUCTION

Central venous catheterisation (CVC) is a technique commonly used to obtain vascular access and over five million CVCs are inserted annually. This systematic review of CVC-related arterial injury aims to compare outcomes reported with different management strategies.

METHODS

PRISMA guidelines were followed. A search of Medline, Embase, Central and CINAHL was performed. Results were limited to papers in humans and in English with duplicates removed. Details of cases including site and nature of arterial injury, use of ultrasound, methods for identifying arterial placement, management methods used, and any reported outcomes were collated from all papers. Successful management was defined as control of haemorrhage without evidence of further complications.

RESULTS

We screened 2187 abstracts and 78 full manuscripts were obtained and reviewed. Twenty-four papers were of relevance and were included in this review. Amongst the papers, 80 cases of arterial injury were reported. Successful treatment by removal and compression, endovascular methods, and open surgical repair were 5.6%, 94.6% and 100%, respectively.

DISCUSSION

Removal and compression of the arterial site is a poor management method and is associated with a high rate of complications. Endovascular approaches had a high rate of success with advantages of endovascular techniques including access to arteries which are difficult to expose surgically and avoidance of general anaesthesia. Endovascular repair might be considered depending on site of injury or local expertise though surgical repair reported the best results in this review with no complications seen.

Conservative management of an iatrogenic arteriovenous fistula

Background

Arteriovenous fistula is an uncommon complication of central venous catheterization that often requires invasive repair.

Case Report

We report the case of an arteriovenous fistula that presented as ongoing pain following removal of a tunneled central venous catheter. The fistula resolved spontaneously following a period of compression and observation.

Conclusion

Our study highlights the etiology of this uncommon complication as well as suggesting a role for conservative management.