Inadvertent catheter placement into the innominate artery successfully repaired with perclose

Abstract

Inadvertent arterial catheterization during central venous access is an uncommon but potentially catastrophic complication, with reported incidence ranging from 0.1% to 1%, depending on technique and patient factors. Injuries involving non-compressible, large-caliber vessels such as the brachiocephalic (innominate) artery are particularly high risk due to the potential for hemorrhage, stroke, pseudoaneurysm formation, and mediastinal hematoma. Historically, management has favored open surgical repair, especially for supra-aortic trunk injuries; however, this approach carries significant morbidity in elderly and medically complex patients.¹ With advances in endovascular techniques, less invasive strategies including covered stent placement and percutaneous suture-mediated closure devices have emerged as viable alternatives. Recent literature supports the use of suture-mediated closure systems, such as Perclose, in select cases of iatrogenic arterial injury, demonstrating high technical success rates and low complication profiles when appropriate imaging, wire access, and procedural planning are employed.¹ These approaches are particularly advantageous in anatomically challenging or surgically hostile fields. We present a case of inadvertent catheterization of the brachiocephalic artery during tunnelled infusion port placement, successfully managed with percutaneous suture-mediated closure. This case highlights the growing role of minimally invasive techniques in the management of central arterial injuries and underscores the importance of early recognition, detailed imaging evaluation, and multidisciplinary coordination. A review of the literature highlights growing evidence supporting endovascular approaches for inadvertent supra-aortic arterial cannulation. Reported success rates of suture-mediated closure devices range from 90–100% in select patients, with reduced morbidity compared to open repair.^1-7 This case demonstrates the feasibility, safety, and efficacy of percutaneous closure for innominate artery injury, reinforcing a paradigm shift toward minimally invasive management.