Accidental Carotid Artery Cannulation: A Case Report and Review of Contemporary Management Techniques

Accidental arterial cannulation is an uncommon but potentially catastrophic complication of central venous catheterization, even in the era of routine ultrasound guidance. We report a case of inadvertent right common carotid artery cannulation during ultrasound-guided central venous access in a critically ill patient in a peripheral hospital. The catheter was advanced intraluminally with its tip projecting into the aortic arch. The patient was transferred to a tertiary vascular center, where computed tomography angiography (CTA) precisely delineated the catheter course and excluded associated vascular injury. Open surgical carotid exploration with controlled catheter removal and primary arterial repair was performed with an uneventful outcome. This case highlights the importance of early recognition, avoidance of blind catheter removal, and imaging-guided decision-making. In particular, the report demonstrates how CTA can accurately define catheter trajectory when the catheter tip extends into the aortic arch, allowing safe operative planning and definitive repair.