Male patient with severe thoracic trauma and hemorrhagic shock was transferred to the ICU with only a small-caliber peripheral venous access. A high-flow central venous catheter (CVC) was placed via left subclavian vein, but the thoracic ascending aorta was accidentally cannulated on its anterolateral surface at the lesser curvature (Fig. 1A: anteroposterior chest X-ray showing the CVC entering the circulatory system through the aortic knob; Fig. 1B: 3D reconstruction from a thoracic CCTA). Once the patient was stabilized, the catheter was removed through a minithoracotomy using 2 pericatheter purse-string sutures to close the defect without complications.

Figure 1

The systematic use of real-time ultrasonography significantly reduces the risk of arterial puncture; however, it requires both experience and time. In this context, intraosseous access has been recognized as a safe and effective option.