Percutaneous Closure after Inadvertent Carotid Artery Cannulation. Puncture Repair with Angio-Seal Deployment

Inadvertent placement of an introducer sheath in an artery during central venous cannulation is rare and can result in devastating complications. Although traditional closure devices have been employed as prompt and adequate treatment, more innovative devices such as collagen plugs are being studied for their efficacy. We report a case of inadvertent insertion of an 8 French sheath into the right carotid artery which occurred in the electrophysiological laboratory during scheduled transjugular measurement of portal pressure gradient. The consultant neuroradiologist successfully removed the arterial sheath and the puncture site was sealed with a collagen-based vascular closure device (Angio-Seal STS Plus). Accidental insertion of an arterial sheath is an uncommon but potentially serious complication of jugular venous catheterization. When the carotid artery is inadvertently cannulated, sheath removal can be complicated by significant hemorrhage and acute dyspnea due to location of the vessel near the upper airways. Although traditional manual compression and closure devices have been effective at restoring hemostasis, collagen seals or plugs may be more viable to treat this precarious situation. This averted an otherwise emergent open surgical procedure to remove the sheath and repair the carotid artery in a high-risk patient.