Multidisciplinary Management of Subclavian Artery Perforation and Complications

The radial approach to cardiac catheterization and percutaneous coronary interventions has increased in popularity due to the favorable side effect profile relative to the femoral approach. Mediastinal hematoma after radial access cardiac catheterization has scarcely been reported in the literature...

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Bibliographic Details
Published in:Curēus (Palo Alto, CA) CA), 2020-05, Vol.12 (5)
Main Authors: Rizk, Tony, Patel, Darren, Young, Emilee, Ramakrishnan, Vijay, Mansour, Khaled
Format: Article
Language:English
Subjects:
Angioplasty
Back pain
Cardiac catheterization
Cardiac stress tests
Cardiac/Thoracic/Vascular Surgery
Cardiology
Cardiovascular disease
Case reports
Catheters
Dopamine
Hematoma
Hypotension
Intubation
Medical imaging
Mortality
Radiology
Stents
Vital signs
Wire
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Summary:The radial approach to cardiac catheterization and percutaneous coronary interventions has increased in popularity due to the favorable side effect profile relative to the femoral approach. Mediastinal hematoma after radial access cardiac catheterization has scarcely been reported in the literature and, if present, the exact location of the bleed was rarely identified. In this case presentation, we describe an elective transradial coronary angiography resulting in subclavian artery perforation in close proximity to the vertebral artery, with subsequent mediastinal and cervical hematoma formation. This scenario was managed by immediate imaging of the chest after sudden deterioration raised suspicion of an adverse event during wire navigation. Formation of a mediastinal hematoma is the equivalent of retroperitoneal bleed from the femoral approach and requires rapid recognition, interdisciplinary collaboration, and endovascular management.
ISSN:2168-8184
2168-8184
DOI:10.7759/cureus.8009