Vertebral Artery Injury with Dialysis Catheter

Abstract

Abstract:Vertebral artery pseudo-aneurysms and dissections are known to occur as a result of mechanical manipulations of the cervical region, traumatic injury, spontaneously and iatrogenic injury because of central venous catheterization. Central venous lines have become an integral part of patient care, but they are not without complications. Vertebral artery injury (leading to pseudo-aneurysm and dissection) is one of the rarer complications of central venous catheter placement. We report a case of inadvertent vertebral artery catheterization during a dialysis catheter placement which subsequently demonstrated arterial blood. Duplex ultrasound and computed tomographic (CT) scan confirmed vertebral artery catheterization. It was successfully treated with open surgical technique by the vascular surgeon because of the size of catheter and subsequent requirement of artery repair. There were no neurological sequelae. Open surgical repair remains the gold standard of treatment. Endovascular repair of vertebral artery pseudo-aneurysms has been described with promising outcomes, but long-term results are lacking. This case report describes the rare iatrogenic event of vertebral artery injury and reviews its etiology, diagnosis, complications, and management.