SIMULTANEOUS BRACHIOCEPHALIC VEIN AND ASCENDING AORTIC INJURY DURING TUNNELED HEMODIALYSIS CATHETER PLACEMENT: A CASE REPORT
HAGIA SOPHIA 11th INTERNATIONAL CONFERENCE ON MULTIDISCIPLINARY SCIENTIFIC STUDIES , İstanbul, Turkey, 15 - 16 August 2026, pp.809-814, (Full Text)
- Publication Type: Conference Paper / Full Text
- City: İstanbul
- Country: Turkey
- Page Numbers: pp.809-814
- Open Archive Collection: AVESIS Open Access Collection
- Recep Tayyip Erdoğan University Affiliated: Yes
Abstract
ABSTRACT Background: Tunneled hemodialysis catheters are widely used for vascular access; however, central venous and aortic injuries are rare and potentially fatal complications. We present the successful surgical management of simultaneous brachiocephalic vein and ascending aortic injury during catheter placement. Case Presentation: A 64-year-old man with end-stage kidney disease resumed hemodialysis after renal allograft rejection. During right internal jugular tunneled catheter placement under fluoroscopic guidance, the guidewire was advanced through the brachiocephalic vein and superior vena cava into the right atrium. After insertion of the peel-away sheath and removal of the guidewire, contrast injection through the sheath demonstrated pulsatile aortic opacification with active extravasation. Partial withdrawal of the sheath was followed by sudden hypotension and altered consciousness. Cardiac arrest did not occur, and cardiopulmonary resuscitation was not required. The sheath was left partially in situ, the patient was intubated, and emergency surgery was undertaken. Median sternotomy revealed a large fresh mediastinal hematoma and an injured brachiocephalic vein, which was repaired primarily. The sheath was removed under surgical control. A small actively bleeding perforation on the left anterolateral aspect of the ascending aorta was closed primarily with 4‑0 polypropylene suture without cardiopulmonary bypass. Fresh clots were evacuated from the left pleural cavity. A total of six units of packed red blood cells and one unit of fresh frozen plasma were administered during the perioperative and intensive care periods. The patient remained in intensive care for two days and on the ward for five days before being discharged in good condition. Conclusion: When inadvertent arterial entry or major vascular injury is suspected, uncontrolled removal of a large-bore sheath should be avoided. Immediate multidisciplinary coordination and removal under surgical or endovascular control may prevent catastrophic hemorrhage. Keywords: Tunneled hemodialysis catheter; ascending aortic injury; brachiocephalic vein injury; iatrogenic vascular injury; emergency surgery