Case Report
Volume 5 Issue 6 - 2022
Subclavian Artery Injury Secondary to Central Venous Catheter Insertion

José Alberto Martinez Valdes1*, Angelica Madelein Aguirre Rodriguez1, Rafael Rivera Garcia1, José Nicolas García Martin del Campo2, Cynthia Carolina Villegas Ramirez1, José Luis Necoechea Camuñez1, Wendy García Sanchez1, Juan Carlos Hernández Ordoñez1, Dan Jeerebai Castro Solorzano1, Anahí Nava Lopez1 and Gema Méndez Barrón1

1General Surgeon, Department of General Surgery at “Ticoman General Hospital” General Hospital of the Secretary of Health of Mexico City, National Autonomous University of Mexico, Mexico City, Mexico

2Colon and Rectum Surgeon and General Surgeon, Department of General Surgery at “Ticoman General Hospital” General Hospital of the Secretary of Health of Mexico City, National Autonomous University of Mexico, Mexico City, Mexico

*Corresponding Author: José Alberto Martinez Valdes, General Surgeon, Department of General Surgery at “Ticoman General Hospital” General Hospital of the Secretary of Health of Mexico City, National Autonomous University of Mexico, Mexico City, Mexico.
Received: April 21, 2022; Published: May 27, 2022


Introduction: Involuntary catheterization of the subclavian artery during an attempt at central venous access is a well-known complication. Historically, these patients are managed with an open surgical approach and repaired under direct vision through an infraclavicular/or supraclavicular incision.

Depending on the situation and the exact location of the arterial lesion, a covered stent, vascular closure device, tract embolization, or gradual reduction of catheter size may be used trans arterial. The method of treatment will depend on a variety of factors.

As for an open approach, the location and anatomy of the subclavian artery pose challenges in surgical exposure, which often require sternotomy or clavicular resection for adequate exposure of vessel and adequate vascular control and perform a primary closure or failing that a Vaso-vessel anastomosis.


Objective: Presentation of a clinical case at the General Hospital of Ticomán, of the Ministry of Health of Mexico City, of an inadvertent lesion of the subclavian artery secondary to the placement of a Central Venous Catheter to all the surgical community

Results: Male patient of 32 years of age, with a history of chronic alcoholism since the age of 19, who goes to the emergency department presenting nausea accompanied by vomiting of gastrobiliary content on more than 10 occasions, as well as intolerance to the oral route, oppressive type abdominal pain of predominance in epigastrium with intensity 9/10, with irradiation towards right hypochondrium, vital signs within normal parameters to physical examination is found with paleness of integuments, with moderate dehydrating, localized abdominal pain in epigastrium and right hypochondrium, Murphy present, positive pancreatic points, being diagnosed with Moderately Severe Acute Pancreatitis of ethyl origin, adverse event is reported for multiple failed attempts in right subkey, as well as multiple failed attempts in left subclavian with metal guide entrapment so it is control x-ray in which metal guide screwing is observed at the level of the 2nd intercostal space, patient is sent to Vascular Surgery, where metal guide is removed and left subclavian central venous catheter is placed without complications, Radiographic control is taken observing Right hemothorax of more than 50% so endopleural probe is placed with an expenditure of 1250cc to its placement of frank hematic appearance, with hemodynamic deterioration, so surgical treatment of urgency performing right anterolateral thoracotomy/Right Subclavian Vascular Examination/Right Subclavian Artery Primary Closure/Middle Sternotomy/Placement of Right Endopleural Probe in 5th Intercostal Space.

Discussion: The insertion of central venous catheters into the subclavian vein was first described by Aubaniac in 1952. Since then, millions of central venous catheters have been placed each year by medical and surgical specialists in the femoral, internal jugular, and subclavian veins. Involuntary catheterization of the subclavian artery during an attempt at central venous access is a well-known complication. Historically, these patients are managed with an open surgical approach and repair under direct vision through an infraclavicular and/or supraclavicular incision.

Inadvertent arterial puncture with a small-caliber needle is usually benign and occurs in about 5% of cases. The consequences can be much more severe if a large-caliber catheter is placed in the artery (> 7 French), and this is estimated to occur in 0.1 to 0.8% of cases. Accidental artery canalization has traditionally been treated with open surgery, using a supraclavicular and/or infraclavicular approach.

Complications described in the literature by the placement of a central venous catheter include arteriovenous fistulas, pseudoaneurysms, hemothorax, and pneumothorax. A recent case series and a review by Guilbert., et al. showed that immediate removal of the blind catheter from the artery with external compression resulted in a higher complication rate of 47% and a mortality rate of 12%.

Conclusion: Failed insertion attempts are the strongest predictor of complications. Complication rates from failed insertion attempts for a CVC are higher for access through the subclavian vein compared to the internal jugular vein. There are several therapeutic options to successfully manage iatrogenic lesions of the subclavian either through an open approach or endovascular management.


Keywords: Injury; Artery; Subclavian; Central Venous Catheter; Hemothorax


  1. Aubaniac R. “Subclavian intravenous injection; advantages and technique”. La Presse Médicale 60 (1952): 1456.
  2. Cayne NS., et al. “Experience and Technique for the Endovascular Management of Iatrogenic Subclavian Artery Injury”. Annals of Vascular Surgery1 (2010): 44-47.
  3. Golden LR. “Incidence and management of large-bore introducer sheath puncture of the carotid artery”. The Journal of Cardiothoracic and Vascular Anesthesia 11 (1997): 851-855.
  4. Reuber M., et al. “Stroke after internal jugular venous cannulation”. Acta Neurologica Scandinavica 105 (2002): 235-239.
  5. Guilbert MC., et al. “Arterial trauma during central venous catheter insertion: case series, review and proposed algorithm”. Journal of Vascular Surgery 48 (2008): 918-925.
  6. Herrmann JW., et al. “Endovascular Repair of Concomitant Vertebral Artery and Subclavian Artery Iatrogenic Perforations”. Annals of Vascular Surgery4 (2015): 838.e17-838.e20.
  7. Eisen LA., et al. “Mechanical complications of central venous catheters”. Journal of Intensive Care Medicine 21 (2006): 40-46.
  8. Mansfield P., et al. “Complications and failures of subclavian vein catheterization”. The New England Journal of Medicine 331 (1994): 1735-1738.
  9. Lefrant JY., et al. “Risk factors of failure and immediate complication of subclavian vein catheterization in critically ill patients”. Intensive Care Medicine 28 (2002): 1036-1041.
  10. Takeyama H., et al. “Limiting vein puncture to three needle passes in subclavian vein catheterization by the infraclavicular approach”. Surgery Today 36 (2006): 779-782.
  11. Foster PJ., et al. “Central venous catheterization in patients with coagulopathy”. Archives of Surgery 127 (1992): 273-275.
  12. DeLoughery TG., et al. “Invasive line placement in critically ill patients: do hemostatic defects matter?” Transfusion 36 (1996): 827-831.
  13. Barrera R., et al. “Acute complications of central line placement in profoundly thrombocytopenic cancer patients”. Cancer 78 (1996): 2025-2030.
  14. Petersen GA. “Does systemic anticoagulation increase the risk of internal jugular vein cannulation?” Anesthesiology 75 (1991): 1124.
  15. Fisher NC and Mutimer DJ. “Central venous cannulation in patients with liver disease and coagulopathy-a prospective audit”. Intensive Care Medicine 25 (1999): 481-485.
  16. Goldfarb G and Lebrec D. “Percutaneous cannulation of the internal jugular vein in patients with coagulopathies. An experience based on 1,000 attempts”. Anesthesiology 56 (1982): 321-323.
  17. Lee HS., et al. “Safety of thrombolytic treatment in patients with central venous cannulation”. British Heart Journal 73 (1995): 359-362.
  18. Denys BG., et al. “Ultrasound-assisted cannulation of the internal jugular vein. A prospective comparison to the external Landmark-Guided Technique”. Circulation 87 (993): 1557-1562.
  19. Verghese ST., et al. “Ultrasound-guided internal jugular venous cannulation in infants. A prospective comparison with the traditional palpation method”. Anesthesiology 91 (1999): 71-77.
  20. Merrer J., et al. “Complications of femoral and subclavian venous catheterization in critically ill patients. A randomized controlled trial”. The Journal of the American Medical Association 286 (2001): 700-707.
  21. Kulvatunyou N., et al. “A subclavian artery injury, secondary to internal jugular vein cannulation, is a predictable rightsided phenomenon”. Anesthesia and Analgesia 95 (2002): 564-566.
  22. Yerdel MA., et al. “Mechanical complications of subclavian vein catheterization. A prospective study”. International Surgery 76 (19991): 18-22.
  23. Kapadia S., et al. “Endovascular covered stent for management of arterial pseudoaneurysms after central venous access”. The Journal of Cardiothoracic and Vascular Anesthesia 21 (2007): 99-102.
  24. Jeganathan R., et al. “Iatrogenic subclavian artery pseudoaneurysm causing airway compromise: treatment with percutaneous thrombin injection”. Journal of Vascular Surgery 40 (2004): 371-374.
  25. Hernandez JA., et al. “Subclavian artery pseudoaneurysm successful exclusion with a covered self-expanding stent”. Journal of Invasive Cardiology 14 (2002): 278-279.
  26. Kemmerer SR., et al. “Treatment of subclavian artery pseudoaneurysm with use of USguided percutaneous thrombin injection”. Journal of Vascular and Interventional Radiology 11 (2000): 1039-1042.
  27. Abi-Jaoudeh N., et al. “Management of Subclavian Arterial Injuries following Inadvertent Arterial Puncture during Central Venous Catheter Placement”. Journal of Vascular and Interventional Radiology3 (2009): 396-402.
  28. Nicholson T., et al. “Managing inadvertent arterial catheterization during central venous access procedures”. Cardio Vascular and Interventional Radiology 27 (2004): 2125.
  29. Castelli P., et al. “Endovascular repair of traumatic injuries of the subclavian and axillary arteries”. Injury 36 (2005): 778-782.
Citation: José Alberto Martinez Valdes., et al. “Subclavian Artery Injury Secondary to Central Venous Catheter Insertion”. EC Clinical and Medical Case Reports 5.6 (2022): 46-53.

PubMed Indexed Article

EC Pharmacology and Toxicology
LC-UV-MS and MS/MS Characterize Glutathione Reactivity with Different Isomers (2,2' and 2,4' vs. 4,4') of Methylene Diphenyl-Diisocyanate.

PMID: 31143884 [PubMed]

PMCID: PMC6536005

EC Pharmacology and Toxicology
Alzheimer's Pathogenesis, Metal-Mediated Redox Stress, and Potential Nanotheranostics.

PMID: 31565701 [PubMed]

PMCID: PMC6764777

EC Neurology
Differences in Rate of Cognitive Decline and Caregiver Burden between Alzheimer's Disease and Vascular Dementia: a Retrospective Study.

PMID: 27747317 [PubMed]

PMCID: PMC5065347

EC Pharmacology and Toxicology
Will Blockchain Technology Transform Healthcare and Biomedical Sciences?

PMID: 31460519 [PubMed]

PMCID: PMC6711478

EC Pharmacology and Toxicology
Is it a Prime Time for AI-powered Virtual Drug Screening?

PMID: 30215059 [PubMed]

PMCID: PMC6133253

EC Psychology and Psychiatry
Analysis of Evidence for the Combination of Pro-dopamine Regulator (KB220PAM) and Naltrexone to Prevent Opioid Use Disorder Relapse.

PMID: 30417173 [PubMed]

PMCID: PMC6226033

EC Anaesthesia
Arrest Under Anesthesia - What was the Culprit? A Case Report.

PMID: 30264037 [PubMed]

PMCID: PMC6155992

EC Orthopaedics
Distraction Implantation. A New Technique in Total Joint Arthroplasty and Direct Skeletal Attachment.

PMID: 30198026 [PubMed]

PMCID: PMC6124505

EC Pulmonology and Respiratory Medicine
Prevalence and factors associated with self-reported chronic obstructive pulmonary disease among adults aged 40-79: the National Health and Nutrition Examination Survey (NHANES) 2007-2012.

PMID: 30294723 [PubMed]

PMCID: PMC6169793

EC Dental Science
Important Dental Fiber-Reinforced Composite Molding Compound Breakthroughs

PMID: 29285526 [PubMed]

PMCID: PMC5743211

EC Microbiology
Prevalence of Intestinal Parasites Among HIV Infected and HIV Uninfected Patients Treated at the 1o De Maio Health Centre in Maputo, Mozambique

PMID: 29911204 [PubMed]

PMCID: PMC5999047

EC Microbiology
Macrophages and the Viral Dissemination Super Highway

PMID: 26949751 [PubMed]

PMCID: PMC4774560

EC Microbiology
The Microbiome, Antibiotics, and Health of the Pediatric Population.

PMID: 27390782 [PubMed]

PMCID: PMC4933318

EC Microbiology
Reactive Oxygen Species in HIV Infection

PMID: 28580453 [PubMed]

PMCID: PMC5450819

EC Microbiology
A Review of the CD4 T Cell Contribution to Lung Infection, Inflammation and Repair with a Focus on Wheeze and Asthma in the Pediatric Population

PMID: 26280024 [PubMed]

PMCID: PMC4533840

EC Neurology
Identifying Key Symptoms Differentiating Myalgic Encephalomyelitis and Chronic Fatigue Syndrome from Multiple Sclerosis

PMID: 28066845 [PubMed]

PMCID: PMC5214344

EC Pharmacology and Toxicology
Paradigm Shift is the Normal State of Pharmacology

PMID: 28936490 [PubMed]

PMCID: PMC5604476

EC Neurology
Examining those Meeting IOM Criteria Versus IOM Plus Fibromyalgia

PMID: 28713879 [PubMed]

PMCID: PMC5510658

EC Neurology
Unilateral Frontosphenoid Craniosynostosis: Case Report and a Review of the Literature

PMID: 28133641 [PubMed]

PMCID: PMC5267489

EC Ophthalmology
OCT-Angiography for Non-Invasive Monitoring of Neuronal and Vascular Structure in Mouse Retina: Implication for Characterization of Retinal Neurovascular Coupling

PMID: 29333536 [PubMed]

PMCID: PMC5766278

EC Neurology
Longer Duration of Downslope Treadmill Walking Induces Depression of H-Reflexes Measured during Standing and Walking.

PMID: 31032493 [PubMed]

PMCID: PMC6483108

EC Microbiology
Onchocerciasis in Mozambique: An Unknown Condition for Health Professionals.

PMID: 30957099 [PubMed]

PMCID: PMC6448571

EC Nutrition
Food Insecurity among Households with and without Podoconiosis in East and West Gojjam, Ethiopia.

PMID: 30101228 [PubMed]

PMCID: PMC6086333

EC Ophthalmology
REVIEW. +2 to +3 D. Reading Glasses to Prevent Myopia.

PMID: 31080964 [PubMed]

PMCID: PMC6508883

EC Gynaecology
Biomechanical Mapping of the Female Pelvic Floor: Uterine Prolapse Versus Normal Conditions.

PMID: 31093608 [PubMed]

PMCID: PMC6513001

EC Dental Science
Fiber-Reinforced Composites: A Breakthrough in Practical Clinical Applications with Advanced Wear Resistance for Dental Materials.

PMID: 31552397 [PubMed]

PMCID: PMC6758937

EC Microbiology
Neurocysticercosis in Child Bearing Women: An Overlooked Condition in Mozambique and a Potentially Missed Diagnosis in Women Presenting with Eclampsia.

PMID: 31681909 [PubMed]

PMCID: PMC6824723

EC Microbiology
Molecular Detection of Leptospira spp. in Rodents Trapped in the Mozambique Island City, Nampula Province, Mozambique.

PMID: 31681910 [PubMed]

PMCID: PMC6824726

EC Neurology
Endoplasmic Reticulum-Mitochondrial Cross-Talk in Neurodegenerative and Eye Diseases.

PMID: 31528859 [PubMed]

PMCID: PMC6746603

EC Psychology and Psychiatry
Can Chronic Consumption of Caffeine by Increasing D2/D3 Receptors Offer Benefit to Carriers of the DRD2 A1 Allele in Cocaine Abuse?

PMID: 31276119 [PubMed]

PMCID: PMC6604646

EC Anaesthesia
Real Time Locating Systems and sustainability of Perioperative Efficiency of Anesthesiologists.

PMID: 31406965 [PubMed]

PMCID: PMC6690616

EC Pharmacology and Toxicology
A Pilot STEM Curriculum Designed to Teach High School Students Concepts in Biochemical Engineering and Pharmacology.

PMID: 31517314 [PubMed]

PMCID: PMC6741290

EC Pharmacology and Toxicology
Toxic Mechanisms Underlying Motor Activity Changes Induced by a Mixture of Lead, Arsenic and Manganese.

PMID: 31633124 [PubMed]

PMCID: PMC6800226

EC Neurology
Research Volunteers' Attitudes Toward Chronic Fatigue Syndrome and Myalgic Encephalomyelitis.

PMID: 29662969 [PubMed]

PMCID: PMC5898812

EC Pharmacology and Toxicology
Hyperbaric Oxygen Therapy for Alzheimer's Disease.

PMID: 30215058 [PubMed]

PMCID: PMC6133268

News and Events

January Issue Release

We always feel pleasure to share our updates with you all. Here, notifying you that we have successfully released the November issue of respective journals and the latest articles can be viewed on the current issue pages.

Submission Deadline for Upcoming Issue

ECronicon delightfully welcomes all the authors around the globe for effective collaboration with an article submission for the upcoming issue of respective journals. Submissions are accepted on/before February 14, 2023.

Certificate of Publication

ECronicon honors with a "Publication Certificate" to the corresponding author by including the names of co-authors as a token of appreciation for publishing the work with our respective journals.

Best Article of the Issue

Editors of respective journals will always be very much interested in electing one Best Article after each issue release. The authors of the selected article will be honored with a "Best Article of the Issue" certificate.

Certifying for Review

ECronicon certifies the Editors for their first review done towards the assigned article of the respective journals.

Latest Articles

The latest articles will be updated immediately on the articles in press page of the respective journals.