26 Indian Journal of Forensic Medicine & Toxicology, January-March 2021, Vol. 15, No. 1 Percutaneous Subclavian Artery Covered Stent Placement Following Inadvertent Subclavian Arterial Cannulation Cinosh Mathew 1 , R Calton 2 1 Associate Professor, Department of Cardiology, SBKS MI & RC, Waghodia, Vadodara, 2 Professor, Department of Cardiology, CMC & H Ludhiana, Punjab, Department of Cardiology, Smt. B. K. Shah Medical Institute and Research Centre, Sumandeep Vidyapeeth Deemed to be University, Vadodara, Gujarat Abstract Inadvertent subclavian artery canulation although rare is a life threatening complication of central venous canulation. Its prompt recognition and management by stent placement, thrombin injection, Angio seal or gel foam embolization is essential to minimize fatal complications. We describe a case report of subclavian arterial canulation which was recognized and managed percutaneously by covered stent placement without complications. Keywords: subclavian arterial; cannulation; covered stent Case Report Corresponding Author: Dr Cinosh Mathew Associate Professor, Department of Cardiology Smt. B. K. Shah Medical Institute and Research Centre, Sumandeep Vidyapeeth Deemed to be University, Piparia,391760, Waghodia, Vadodara, Gujarat, India. Email: cinosh.mathew@gmail.com Mobile no: 9646500159 Introduction Central venous catheter (CVC) cannulation in the subclavian vein of patients wounded in battle was frst described by Aubaniac in 1952. [1] The CVC helps in the management of critical patients in that it provides reliable short to medium term venous access for hemodynamic monitoring, intravenous drug therapy, hemodialysis, parenteral nutrition and rapid fuid resuscitation and is now a commonly performed procedure in ICU setting. [2] Complications of Subclavian vein cannulation include pneumothorax, hydrothorax, hemothorax, local hematoma, vascular injury, thrombo-embolism, and site related infections. [3] Inadvertent subclavian artery puncture during subclavian vein cannulation is a known and serious complication of CVC placement which could lead to hematoma, pseudo aneurysm formation, arterial occlusion, embolism, dissection, stroke, severe airway obstruction and even fatal bleeding on sheath removal as it is an anatomically non compressible site [4, 5]. Removal of inadvertently placed CVC followed by manual compression can lead to complications like uncontrollable bleeding and death. [6] Various techniques have been described to treat the subclavian artery after an inadvertent puncture like stent placement, thrombin injection, Angio seal and gel foam embolization. Techniques such as stent graft placement, thrombin injection, Angio seal devices and Gel foam embolization have been used to repair the subclavian artery after inadvertent puncture [7, 8] . We report a case of inadvertent subclavian artery cancellation, which was successfully closed using a covered stent placed percutaneously. A percutaneous approach is appropriate and justifed management strategy with lesser complications as compared to surgical treatment. [9-11] Case Report A 45 -year-old gentleman, diagnosed with acute pancreatitis had a central venous catheter placement in the surgical ICU. As he was in shock an attempt was made to access the right subclavian vein to place the venous catheter by using an anatomic landmark technique with a 7F triple lumen central venous catheter. However, after gaining access the surgeons noted pulsating blood fow and an arterial puncture was suspected which was confrmed by sending the blood for arterial blood gas analysis. The CVC was not removed due to the risk