Cureus · 5 authors, 1 centre
This summary was generated by AI from a single paper. It has not been reviewed by a clinician and is not clinical advice. Verify against the source before acting on it.
This case report describes a 62-year-old critically ill patient whose central venous catheter was accidentally placed in the right common carotid artery. The catheter was successfully removed using a Perclose-ProGlide closure device, an off-label but effective minimally invasive technique. A literature review of 15 similar cases found a 93.3% technical success rate with closure devices, suggesting they may be a safe first-line option, especially in unstable patients.
**Background:** Central venous catheter (CVC) placement is a common procedure in hospitalized patients, with over 5 million placed annually in the United States. Despite ultrasound guidance now being mandatory, inadvertent arterial puncture occurs in 2%-4.5% of cases, with arterial injury in 0.1%-0.5%. When the internal jugular vein is accessed, incidental arterial puncture is reported between 6.3% and 9.4%, and arterial cannulation occurs in approximately 1% of cases. Complications of carotid artery catheterization include bleeding, hematoma, pseudoaneurysm, dissection, arteriovenous fistula, stroke, and death. Traditional management options include manual compression (hazardous for catheters ≥7Fr), open surgical repair (safe but requires general anesthesia in critically ill patients), and endovascular treatment with covered stents (minimally invasive but requires long-term antiplatelet therapy). Percutaneous closure devices, though approved only for femoral artery use, have been used off-label in various arterial territories.
**Methods:** A 62-year-old male with atrial fibrillation, hypertension, cardiac failure, and morbid obesity presented with acute respiratory failure from a lower respiratory infection. After intubation and ICU transfer, a triple-lumen 7Fr CVC was accidentally placed in the right common carotid artery during attempted right internal jugular vein cannulation. The misplaced catheter was identified by pulsating back-bleeding and confirmed by bedside duplex ultrasound. Due to the patient's severe condition and short, wide neck, the decision was made to remove the catheter using a Perclose-ProGlide closure device. A hydrophilic stiff guidewire (0.035''-180cm) was introduced through the distal lumen, the CVC was removed over the wire with manual compression, and the Perclose-ProGlide device was advanced and deployed per instructions for use. Hemostasis was verified by ultrasound. A systematic literature review of PubMed (2000-2022) using the terms "central venous catheter" OR "central line" AND "closure device" identified 72 results; inclusion criteria were case reports or series of misplaced CVC in the carotid artery treated with any percutaneous closure device.
**Key Results:** The procedure was technically successful with immediate hemostasis confirmed by ultrasound, no manual compression required, and no postoperative complications. The literature review identified eight publications with 15 patients. Catheter sizes were: 7Fr (40%, n=6), 8.5Fr (40%, n=6), 9Fr (6.6%, n=1), 6Fr (6.6%, n=1), and 12Fr (6.6%, n=1). The most commonly used device was Perclose-ProGlide (53.3%, n=8), followed by Boomerang (13.3%, n=2), Exoseal (13.3%, n=2), and one each of Mynx, StarClose, and AngioSeal (6.6% each). An embolic protection device (Spider FX) was used in one case. Overall technical success was 93.3% (n=14). In one patient with a 9Fr catheter, ExoSeal failed to achieve complete sealing, requiring secondary endovascular stent graft deployment (Fluency 10x40mm).
**Clinical Implications:** Percutaneous closure devices offer a safe, quick, minimally invasive, and effective treatment option for inadvertent carotid artery catheterization, particularly in frail or unstable patients. The procedure can potentially be performed at the bedside. Despite the off-label nature of this application (devices are FDA-approved only for common femoral artery use), the cumulative evidence from 16 reported cases (including the present one) demonstrates high technical success. The authors suggest these devices should be considered as first-line treatment, but acknowledge that wider adoption requires comparative studies between different devices and treatment options rather than reliance on case reports and small case series.