A minimally invasive technique of closing an iatrogenic subclavian artery cannulation using the Angio-Seal closure device: two case reports (Journal of Medical Case Reports)

IntroductionIn two cases described here, a puncture of the subclavian artery, which had been inadvertently cannulated during unsuccessful access of the internal jugular vein, was successfully closed by using a closure device based on a collagen plug (Angio-Seal, St. Jude Medical, St. Paul, MN, USA). This technique is relatively simple and inexpensive. It can provide clinicians (intensive care physicians and anesthesiologists) with a safe and straightforward alternative to major surgery and can be a life-saving procedure.Case presentationDuring pre-operative preparation in a 66-year-old Caucasian man, an anesthetist attempted ultrasound-guided right internal jugular venous access. A 7-French (7F) triple-lumen catheter was inadvertently placed in the arterial system. In a second case, in a 77-year-old Caucasian woman, an emergency physician inadvertently placed a 7F catheter in the subclavian artery during right internal jugular vein access. By means of a closure device (Angio-Seal), both arterial punctures were successfully closed percutaneously. No complications were observed. Conclusions: Inadvertent subclavian arterial puncture can be successfully managed with no adverse clinical sequelae by using a percutaneous vascular closure device. This minimally invasive technique may be an option for patients with non-compressible arterial punctures. This article demonstrates two practical points that may help clinicians in decision making during daily practice. First, it provides a practical solution to a well-known vascular complication. Second, it emphasizes a role for proper vascular ultrasound training for the non-radiologist.