Cardiovascular Journal of Africa: Vol 27 No 4 (July/August 2016)

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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 27, No 4, July/August 2016 AFRICA e17
An unusual condition during internal jugular vein
catheterisation: vertebral artery catheterisation
Ozge Korkmaz, Sabahattin Göksel, Burçak Söylemez, Kasım Durmuş, Ahmet Cemil İşbir, Öcal Berkan
Abstract
Vertebral artery cannulation is an unusual complication
during internal jugular vein cannulation. We report a case
of vertebral artery cannulation, which occurred during an
attempt to cannulate the right internal jugular vein, and we
discuss the management of such a rare complication.
Keywords: vertebral artery, cannulation, internal jugular vein,
anterior forminectomy, complication
Submitted 20/11/15, accepted 30/3/16
Published online 27/5/16
Cardiovasc J Afr 2016; 27: e17–e19
DOI: 10.5830/CVJA-2016-040
Internal jugular vein catheterisation is an essential procedure,
specifically in major operations, such as cardiac surgery. Vertebral
artery cannulation is a rare complication during internal jugular
vein cannulation, but it may lead to sequelae that could prove
fatal. When this condition occurs, it should be diagnosed quickly
and treated as soon as possible.1
This case discusses a patient who had inadvertent vertebral
artery cannulation during internal jugular vein access in
the operating room for coronary bypass surgery. The right
vertebral artery was repaired via foraminectomy using an intra-
operative anterior approach, and coronary bypass surgery was
subsequently continued.
Case report
A 65-year-old male patient who, following diagnosis of
coronary artery disease, had angiography and was admitted
to the cardiovascular surgery unit for bypass grafting on four
vessels. Carotid and vertebral artery Doppler ultrasonography,
performed during pre-operative preparation of the patient,
revealed no pathology in either the carotid or vertebral arteries.
After preparation, the patient was taken into the operating
room for coronary bypass surgery. Peripheral venous and radial
artery catheterisation was completed prior to general anesthaesia.
Following the administration of general anaesthesia, the head of
the patient was placed 15 degrees below the whole body, which
was in the Trendelenburg position, and he was turned to the left.
He was stained and covered under sterile conditions.
The puncture was made by an anaesthetist, using a 18-G
needle, through the apex of the triangle composed of the sternal
and clavicular parts of the sternocleidomastoid muscle. During
puncture, the blood was established not to be bright in colour
or pulsatile, and a 12-F × 15-cm double-lumen catheter was
inserted using the Seldinger method. However, the blood from
the catheter was bright and pulsatile, and so the catheter tip was
attached to a transducer. From the arterial trace and the arterial
nature of the blood sample taken, it was assumed that carotid
artery catheterisation had been performed.
Doppler ultrasonography was carried out in the operating
room on the patient under general anaesthesia. It was observed
that the catheter was not in the carotid artery, and therefore
the carotid artery was accessed by surgical exploration
through an incision at the catheter tip. It was established from
ultrasonography that the catheter had advanced deeper towards
the cervical vertebrae.
In the ensuing minutes, brain, and head and neck surgeons
were invited to the operating room. With neck dissection, the
anterolateral view of the C5–C6–C7 vertebrae was accessed. It
was seen that the catheter had entered through the C5–C6 disc
space and had gone into the C6 vertebral foramen. The catheter
was found to be in the subclavian artery of C7.
Foraminectomy was performed anterior to the foramen of the
C6 vertebra. This region was cleared and it was established that
the catheter had advanced through the vertebral artery and was
in the subclavian artery (Fig. 1). The catheter was withdrawn in
a controlled manner, the existing vascular damage was primarily
repaired, and coronary bypass surgery was then initiated.
During the operation, neurological soundness of the patient
was followed up by the anaesthetists (pupil reflexes, absence
of anisocoria, etc). The operation was completed without any
problems and the patient was taken to the intensive care unit. He
Department of Cardiovascular Surgery, Cumhuriyet
University Medical Faculty, Sivas, Turkey
Ozge Korkmaz, MD,
Sabahattin Göksel, MD
Öcal Berkan, MD
Department of Neurosurgery, Cumhuriyet University
Medical Faculty, Sivas, Turkey
Burçak Söylemez, MD
Department of Head and Neck Surgery, Cumhuriyet
University Medical Faculty, Sivas, Turkey
Kasım Durmuş, MD
Department of Anaesthesilology and Reanimation,
Cumhuriyet University Medical Faculty, Sivas, Turkey
Ahmet Cemil İşbir, MD
Case Report