Amplatzer Plug Embolization for Iatrogenic Aortic Arch Catheterization: A Rescue Technique

supra-aortic vessels without complete aortic arch replacement, presented to the emergency department with hypotension, tachycardia, dyspnea, and fever up to 38.8 °C.Her history also included persistent atrial fibrillation, hypertensive heart disease (NYHA III), multifactorial anemia, and recent INR derangement under phenprocoumon therapy complicated by spontaneous subdural and sublingual hematomas.Due to poor peripheral venous access, a central venous catheter (CVC) was placed pre-hospital in the left subclavian region using a landmark-based technique.On admission, the patient required continuous catecholamine support.Pulsatile blood return from the catheter prompted arterial blood gas analysis, confirming arterial placement.Laboratory findings and clinical presentation were consistent with septic shock.Blood and urine cultures grew Proteus mirabilis, confirming urosepsis.CT imaging demonstrated catheter malposition within the aortic arch after traversing the left upper lobe, along with chronic postsurgical changes (Fig. 1).The patient was stabilized in the intensive care unit (ICU) with intravenous meropenem and vasopressor therapy.Following clinical improvement and resolution of fever, management options were reassessed.Given extreme surgical risk, a minimally invasive endovascular strategy was preferred.However, standard stent-graft therapy was not feasible due to the catheter's proximity to the reimplanted supra-aortic branches.After multidisciplinary discussion, endovascular retrieval with tract embolization was planned.Under general anesthesia, the right common femoral artery was accessed under ultrasound guidance and a 5F sheath was placed, later upsized to a 7Fr/90 cm sheath.Through the malpositioned left pectoral 7Fr triple-lumen CVC, 0.035'' and 0.014'' guidewires were advanced into the descending aorta.The 0.035'' guidewire was captured using a 20 mm Gooseneck snare via femoral access, establishing