Aortic perforation from central venous catheterization: a near-miss catastrophe

Central venous catheterization for hemodialysis access carries a risk of inadvertent arterial cannulation, which can lead to catastrophic complications, including aortic arch perforation. We report the case of a 61-year-old man with stage 5 chronic kidney disease who sustained an aortic perforation during an attempted right internal jugular vein cannulation at an outside institution. Computed tomography angiography revealed the catheter traversing the right common carotid artery and brachiocephalic trunk, with an extraluminal tip located in the aortic arch, accompanied by hemopericardium and a periaortic hematoma. Emergent surgical removal was performed under direct visualization with manual compression and standby cardiopulmonary bypass, and the patient recovered uneventfully. This case underscores the essential role of real-time ultrasound guidance in preventing arterial injury. When arterial cannulation is suspected, blind catheter withdrawal must be strictly avoided, and prompt imaging, immediate surgical consultation, and controlled catheter extraction are critical to averting fatal hemorrhage.