Persistent atrial fibrillation following central venous cannulation

Iatrogenic subclavian artery pseudoaneurysm causing airway compromise: treatment with percutaneous thrombin injection

Central venous cannulation is an increasingly common diagnostic and therapeutic procedure in modern medical practise. Inadvertent iatrogenic injury to an adjacent major artery during attempted central venous cannulation is an uncommon but potentially lethal complication. If injury leads to pseudoaneurysm formation, complications may arise from mass effect, embolism, or even rupture with continued hemorrhage. Traditional surgical repair of these lesions is often difficult, especially if access within the thorax is required in patients at high risk. We present a case report of successful management of a large subclavian artery pseudoaneurysm with the new approach of percutaneous thrombin injection.

Ruptured superior thyroid artery from central vein cannulation: treatment by coil embolization

Central vein cannulation is associated with several complications, some of which may be fatal. This case report describes a life-threatening complication after insertion of a central venous line. An obese female patient with end-stage renal failure due to nephrotic syndrome developed a huge neck swelling and sudden airway obstruction after attempted cannulation of the internal jugular vein for haemodialysis. Tracheal intubation was achieved using a gum-elastic bougie. Investigations revealed abnormal blood clotting. The coagulopathy was treated, but the neck swelling continued to increase in size. Carotid angiography showed a ruptured right superior thyroid artery. The haemorrhage was controlled by coil embolization of the artery. This case report demonstrates the usefulness of the gum-elastic bougie in the presence of a difficult airway and of interventional radiology in the management of vascular accidents.