An Internal Mammary Artery Perforation As a Complication of Central Venous Catheterization

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We describe a case of right internal mammary artery (IMA) perforation as a very rare complication of central venous catheterization (CVC). A 43-year-old woman was hospitalized for anorexia and ascites, and intravenous alimentation was indicated to treat her malnutrition. After failed right jugular vein approach, she complained of chest pain. One hour later when she was in semiconscious state, a right subclavian approach did not allow successful insertion. A later attempt under fluoroscopy revealed collapse of her right lung. A massive right hemothorax was diagnosed by chest computed tomography. When we were consulted 4 hours after the first puncture, she was already deeply comatose due to serious shock. Fluid resuscitation, tracheal intubation and tube thoracostomy were immediately performed. Afterward, we carefully maintained her systolic blood pressure between 80 and 90mmHg with chest tube clamping and declamping, and controlling the infusion rate. Subsequent angiography revealed extravasation of contrast medium from the right IMA, and complete hemostasis was obtained by coil embolization. The patient had no further bleeding and eventually made a full recovery. We should be fully aware of the potentially lethal hazards of CVC. This is apparently the first report of IMA damage during CVC in Japan.
一般社団法人日本救急医学会の論文