Unmasking the Silent Bleed: Subclavian Artery Puncture and Mediastinal Haematoma during Minimally Invasive Oesophagectomy

Video-Assisted Thoracoscopic Oesophagectomy (VATS-E) is a minimally invasive procedure increasingly used for managing oesophageal cancer due to its reduced postoperative morbidity and shorter recovery times. However, it is not without risks, particularly in the perioperative management of patients requiring central venous access. Complications associated with central line placement, such as vascular injuries, can lead to significant morbidity, including rare but life-threatening conditions like mediastinal haematomas. This case report presents an unusual complication encountered during VATS-E. During the insertion of a subclavian central venous line, an inadvertent puncture of the subclavian artery occurred, resulting in the formation of a large mediastinal haematoma. The patient exhibited symptoms of haemodynamic instability, including tachycardia and hypotension, which necessitated urgent intervention. Advanced imaging revealed a localised haematoma compressing mediastinal structures. Management of this critical situation required a multidisciplinary approach involving thoracic surgeons, anaesthesiologists, and interventional radiologists. The haematoma was managed conservatively with continuous haemodynamic monitoring while ensuring that no further vascular compromise or compression occurred. The patient recovered without requiring surgical evacuation of the haematoma, highlighting the potential for non-operative management in selected cases. This report underscores the importance of prompt diagnosis, careful assessment, and collaborative management in addressing such rare complications. By sharing this case, we aim to raise awareness of this potential risk and emphasise strategies to mitigate complications during central line placement in patients undergoing oesophagectomy