Use of suture-mediated closure device system after inadvertent medport placement in the subclavian artery leading to multi-focal ischaemic infarct: a case report.

Abstract

Background: Totally implantable venous access devices or chemoports are progressively being used in oncologic patients for long-term chemotherapy administration. We present the case of an iatrogenic arterial catheter placement in the aortic arch complicated with multi-focal ischaemic stroke.

Case summary: A case of a 73-year-old woman with a history of hypertension, diabetes mellitus, pineal gland tumour status post ventriculoperitoneal shunt, and breast and bladder cancer presented with a 2-week history of impaired balance, dysarthria, and right-sided facial drop. The chemoport was placed less than a month prior to the onset of symptoms at another institution. A brain magnetic resonance imaging revealed a left hemispheric supra- and infra-tentorial subacute ischaemic infarcts. The head and neck computed tomography angiography notably showed a misplaced venous port at the left subclavian artery with a distal tip projecting towards the ascending aortic arch, revealing the most likely aetiology of multi-focal ischaemic stroke. The patient underwent successful subclavian artery catheter extraction and endovascular repair with a suture-mediated closure device system without complications.

Discussion: Subclavian artery iatrogenic cannulation may lead to catastrophic outcomes, including stroke. A high level of suspicion for venous port misplacement must be entertained when ipsilateral multi-focal ischaemic infarct occurs in time relation to catheter placement. Conducting an endovascular catheter retrieval and using a suture-mediated closure device is an alternative approach to manual compression in locations where achieving an haemostasis is challenging. A suture-mediated closure device system might be useful for anatomy not amenable to manual compression, such as the subclavian artery.