Innominate vein repair after iatrogenic perforation with central venous catheter

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Reference:

Siordia, J.A., Ayers, G.R., Garlish, A. and Subramanian, S. (2015) Innominate vein repair after iatrogenic perforation with central venous catheter via mini-sternotomy-Case report. International Journal of Surgery Case Reports. March 18th. [epub ahead of print].

Abstract:

INTRODUCTION: Iatrogenic damage of the innominate vein is a possible complication with extracorporeal central venous line catheter insertion techniques. When perforation occurs, the catheter is left in place and surgery is required for careful removal and repair of other possible complications, including hemothorax and cardiac tamponade. The traditional approach for innominate vein repair is via a complete median sternotomy.

PRESENTATION OF CASE: A 75-year-old female patient with hypertension, diabetes mellitus type two and end stage renal failure, coronary artery disease presenting with iatrogenic innominate vein perforation and pulmonary effusion status post placement of a tunneled hemodialysis catheter through the left subclavian vein.

DISCUSSION: The patient underwent a partial upper sternotomy into the right fourth intercostal space. Ministernotomy and endovascular techniques provide similar outcomes to those of traditional surgical approaches. However, with minimal access and trauma, these new methods provide better post-operative outcomes for patients.

CONCLUSION: The case presented in this report suggests a new approach to replace the traditional complete median sternotomy in attempts to repair the innominate vein. The mini-sternotomy approach provides sufficient visualization of the vessel and surrounding structures with minimal post-operative complications and healing time.

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