Open surgical management of an iatrogenic zone 2 aortic injury following MediPort misplacement: a case report of complex vascular injury

In the United States, around 5 million venous access procedures are performed annually, with over 200,000 of these involving venous port insertions [1, 2]. Percutaneous catheterization for central venous access is a common procedure, nonetheless, can occasionally cause severe complications, some of which include arterial injuries. In this report, we will discuss a rare case of a 48-year-old female, with a recent diagnosis of Stage III ascending colon cancer who underwent a left hemicolectomy with subsequent MediPort placement (PowerPort™ isp M.R.I.™ Implantable port with 8 Fr. Groshong® Valved Catheter), who exhibited an abnormally wide mediastinum on imaging, suggestive of a misplaced Mediport catheter into the aortic arch. This finding prompted her transfer for specialized treatment to our institution. A chest computed tomography angiography (CTA) revealed the catheter perforating the aortic arch at Zone 2 proximal to the origin of the left subclavian artery and extending into the aortic arch lumen. The patient underwent median sternotomy, Mediport removal, aortic arch primary repair, hemothorax evacuation, and chest tube placement. This case highlights the risks of percutaneous venous catheterization, the importance of assistive imaging (Ultrasound, Fluoroscopy, etc.) to aid and confirm adequate placement, especially in large-bore catheters, and the importance of a multidisciplinary approach in the management of severe complications, such as complex vascular injuries.