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Delayed Percutaneous Closure of the Subclavian Artery after Inadvertent Placement of a Hemodialysis Catheter

This letter describes the delayed management, with a percutaneous arterial closure device (Prostar XL, Abbott laboratories), of a hemodialysis catheter accidentally placed in the right subclavian artery (1-4). A 55-year-old obese hemodialysis patient presented with septic shock associated with a left subclavian tunneled hemodialysis catheter. A 12F hemodialysis catheter was accidentally placed in the right subclavian artery. This catheter was removed from the subclavian artery ten days later, under general anesthesia, when the patient was out of shock and the Prostar XL was available. A transfemoral guidewire was placed across the right subclavian artery to allow for pre-operative and completion angiogram and balloon tamponade or stent grafting backup. The central guidewire channel of the catheter was occluded. Clots and eventually fresh blood were aspirated from the flow channels and contrast medium gently injected; the intraarterial position of the catheter was confirmed (Fig. 1). A guidewire was introduced into the flow channel, the cath-