Endovascular Rescue After Jugular Vein Catheter Complications: A Case Report.

BACKGROUND Internal jugular vein catheterization is a primary vascular access method for hemodialysis; however, it carries a risk of complications. Common adverse events include arterial puncture, hematoma, and pneumothorax; rarer but more serious events involve catheter malposition into major arteries. Despite real-time ultrasound guidance, anatomic factors, technical considerations, and patient-specific characteristics may contribute to these adverse outcomes. CASE REPORT A 64-year-old man with end-stage renal disease and decompensated heart failure required urgent dialysis. During ultrasound-guided placement of a 12.5-Fr dual-lumen catheter, the sheath inadvertently traversed the jugular vein, entered the right subclavian artery, and advanced to the aortic arch. Computed tomography angiography confirmed the catheter course. In a hybrid operating room, the arterial injury was successfully managed using an endovascular suture device. This approach achieved hemostasis without additional venous injury and avoided the need for open surgical repair. No evidence of impaired intracranial blood flow was observed during follow-up. Dialysis was resumed via femoral access the following day; the patient was discharged without complications. This case highlights a rare but life-threatening complication of a routine procedure. CONCLUSIONS Real-time ultrasound guidance does not eliminate the risk of serious catheter misplacement during internal jugular vein cannulation. When inadvertent subclavian artery cannulation occurs, an endovascular suture device may provide a rapid and minimally invasive solution avoiding further venous compromise and posing no risk to cerebral perfusion. These findings support consideration of endovascular closure as an option for the management of iatrogenic arterial injuries, particularly in high-risk patients who are unsuitable for major surgery.