Internal Mammary Artery Injury Complicating a Surfacer® Inside-Out Central Venous Catheterization

This paper reports the case of a near fatal arterial injury in a patient undergoing an inside-out catheter placement through an occluded central venous system using the Surfacer® device. The right internal mammary artery (RIMA) was inadvertently lacerated during the procedure leading to cardiovascular collapse. The patient was rescued by transfusion, placement of a chest tube, and coil-embolization of the RIMA. Post-procedure analysis of intraoperative cone beam computerized tomography revealed that this injury was predictable upon imaging, thus underscoring the need for advanced imaging guidance to enhance the safety of this procedure.