Iatrogenic Aortic Arch Injury from Mahurkar Catheter

Abstract

Iatrogenic vascular injuries secondary to hemodialysis catheter placement constitute rare but potentially life-threatening complications. We present the case of a 61-year-old male patient with type 2 diabetes mellitus, arterial hypertension, and chronic kidney disease on hemodialysis, after a failed attempt at Mahurkar catheter placement. Computed tomography angiography revealed inadvertent catheter insertion into the right common carotid artery, with trajectory through the brachiocephalic trunk and aortic arch, extending to the descending thoracic aorta. Multidisciplinary assessment and specialized surgical planning were performed. The patient underwent sternotomy with direct surgical repair, achieving successful hemostatic control and hospital discharge without complications. This case highlights the importance of prevention through the systematic use of ultrasound guidance, immediate confirmation of catheter position, and the availability of a timely surgical or endovascular approach in referral centers. In addition, it contributes to the literature by documenting an unusual location of arterial injury by hemodialysis catheter, reinforcing the need for safety protocols in vascular access procedures.