Brachiocephalic trunk injuries after central venous catheterization: A case series of surgical management and outcomes.

Introduction And Importance: Central venous catheter (CVC) placement is a common procedure, particularly in critically ill patients. However, it carries the risk of vascular complications, including rare and severe injuries to the brachiocephalic trunk (BCT). We present a case series of two patients who developed BCT injuries following tunneled CVC placements, highlighting the critical importance of early diagnosis to prevent fatal outcomes.

Case Presentation: An 89-year-old female with chronic renal failure on hemodialysis developed hypotension, tachycardia, and dyspnea after left subclavian catheter placement. CT imaging revealed a BCT injury with hemomediastinum. Despite urgent median sternotomy for repair, she developed transfusion-related acute lung injury and passed away on postoperative day 1. In contrast, a 68-year-old female with multiple myeloma and chronic kidney disease developed swelling and a drop in hemoglobin following left internal jugular catheter placement. Imaging confirmed a left BCT injury without active bleeding, and she underwent successful surgical repair with recovery, being discharged on postoperative day 6.

Discussion: BCT injury during CVC placement, although rare, is a life-threatening complication. Early diagnosis through imaging, particularly CT, is crucial for guiding surgical intervention. Median sternotomy remains the standard approach for BCT repair, and careful postoperative monitoring is essential, particularly in patients with significant comorbidities.

Conclusion: This case series underscores the importance of prompt recognition and effective management of BCT injuries following CVC placement. Despite the rarity of this complication, these cases emphasize the need for meticulous procedural techniques and vigilant postoperative care to improve patient outcomes in high-risk patient populations.