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ISSN: 1734-9338
Advances in Interventional Cardiology/Postępy w Kardiologii Interwencyjnej
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vol. 12
Original paper

Percutaneous retrieval of centrally embolized fragments of central venous access devices or knotted Swan-Ganz catheters. Clinical report of 14 retrievals with detailed angiographic analysis and review of procedural aspects

Łukasz Kalińczuk, Zbigniew Chmielak, Artur Dębski, Cezary Kępka, Piotr N. Rudziński, Sebastian Bujak, Mirosław Skwarek, Andrzej Kurowski, Zofia Dzielińska, Marcin Demkow

Adv Interv Cardiol 2016; 12, 2 (44): 140–155
Online publish date: 2016/05/11
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Introduction: Totally implantable venous access systems (TIVAS), Swan-Ganz (SG) and central venous catheters (CVC) allow easy and repetitive entry to the central cardiovascular system. Fragments of them may be released inadvertently into the cardiovascular system during their insertion or as a result of mechanical complications encountered during long-term utilization.

Aim: To present results of percutaneous retrieval of embolized fragments of central venous devices or knotted SG and review the procedural aspects with a series of detailed angiographies.

Material and methods: Between January 2003 and December 2012 there were 14 (~0.025%) successful retrievals in 13 patients (44 ±16 years, 15% females) of embolized fragments of TIVAS (n = 10) or CVC (n = 1) or of dislodged guide-wires (n = 2) or knotted SG (n = 1).

Results: Foreign bodies with the forward end located in the right ventricle (RV), as well as those found in the pulmonary artery (PA), often required repositioning with a pigtail catheter as compared to those catheter fragments which were located in the right atrium (RA) and/or great vein and possessed an accessible free end allowing their direct ensnarement with the loop snare (57.0% (4/7) vs. 66.7% (2/3) vs. 0.0% (0/3); p = 0.074 respectively). Procedure duration was 2–3 times longer among catheters retrieved from the PA than among those with the forward edge located in the RV or RA (30 (18–68) vs. 13.5 (11–37) vs. 8 min (8–13); p = 0.054 respectively). The SG catheter knotted in the vena cava superior (VCS) was encircled with the loop snare introduced transfemorally, subsequently cut at its skin entrance and then pulled down inside the 14 Fr vascular sheath.

Conclusions: By using the pigtail catheter and the loop snare, it is feasible to retrieve centrally embolized fragments or knotted central venous access devices.

percutaneous retrieval, embolized fragments, knotted, central venous access devices

Kock HJ, Pietsch M, Krause U, et al. Implantable vascular access systems: experience in 1500 patients with totally implanted central venous port systems. World J Surg 1998; 22: 12-6.
Lin CH, Wu HS, Chan DC, et al. The mechanisms of failure of totally implantable central venous access system: analysis of 73 cases with fracture of catheter. Eur J Surg Oncol 2010; 36: 100-3.
Liu JC, Tseng HS, Chen CY, et al. Percutaneous retrieval of 20 centrally dislodged Port-A catheter fragments. Clin Imaging 2004; 28: 223-9.
Kusminsky RE. Complications of central venous catheterization. J Am Coll Surg 2007; 204: 681-96.
Surov A, Wienke A, Carter JM, et al. Intravascular embolization of venous catheter--causes, clinical signs, and management: a systematic review. JPEN J Parenter Enteral Nutr 2009; 33: 677-85.
Gabelmann A, Kramer S, Gorich J. Percutaneous retrieval of lost or misplaced intravascular objects. AJR Am J Roentgenol 2001; 176: 1509-13.
Kuter DJ. Thrombotic complications of central venous catheters in cancer patients. Oncologist 2004; 9: 207-16.
Chuang MT, Wu DK, Chang CA, et al. Concurrent use of pigtail and loop snare catheters for percutaneous retrieval of dislodged central venous port catheter. Kaohsiung J Med Sci 2011; 27: 514-9.
Karanikas ID, Polychronidis A, Vrachatis A, et al. Removal of knotted intravascular devices. Case report and review of the literature. Eur J Vasc Endovasc Surg 2002; 23: 189-94.
Druskin MS, Siegel PD. Bacterial contamination of indwelling intravenous polyethylene catheters. JAMA 1963; 185: 966-8.
Savage C, Ozkan OS, Walser EM, et al. Percutaneous retrieval of chronic intravascular foreign bodies. Cardiovasc Intervent Radiol 2003; 26: 440-2.
Dotter CT, Rösch J, Bilbao MK. Transluminal extraction of catheter and guide fragments from the heart and great vessels: 29 collected cases. Am J Roentgenol Radium Ther Nucl Med 1971; 111: 467-72.
Aitken DR, Minton JP. The “pinch-off sign”: a warning of impending problems with permanent subclavian catheters. Am J Surg 1984; 148: 633-6.
Hinke DH, Zandt-Stastny DA, Goodman LR, et al. Pinch-off syndrome: a complication of implantable subclavian venous access devices. Radiology 1990; 177: 353-6.
Cheng CC, Tsai TN, Yang CC, et al. Percutaneous retrieval of dislodged totally implantable central venous access system in 92 cases: experience in a single hospital. Eur J Radiol 2009; 69: 346-50.
Aroesty JM, Cohen SI. Traction-induced fracture of a central venous pressure catheter. Chest 1971; 60: 515-6.
Scott WL. Complications associated with central venous catheters. A survey. Chest 1988; 94: 1221-4.
Shimizu A, Lefor A, Nakata M, et al. Embolization of a fractured central venous catheter placed using the internal jugular approach. Int J Surg Case Rep 2014; 5: 219-21.
Bloomfield DA. Techniques of nonsurgical retrieval of iatrogenic foreign bodies from the heart. Am J Cardiol 1971; 27: 538-45.
Bernhardt LC, Wegner GP, Mendenhall JT. Intravenous catheter embolization to the pulmonary artery. Chest 1970; 57: 329-32.
Fisher RG, Ferreyro R. Evaluation of current techniques for nonsurgical removal of intravascular iatrogenic foreign bodies. AJR Am J Roentgenol 1978; 130: 541-8.
Mariano BP Jr, Roper CL, Staple TW. Accidental migration of an intravenous infusion catheter from the arm to the lung. Radiology 1966; 86: 736-8.
Reynen K. 14-year follow-up of central embolization by a guidewire. N Engl J Med 1993; 329: 970-1.
Andrews RE, Tulloh RM, Rigby ML. Percutaneous retrieval of central venous catheter fragments. Arch Dis Child 2002; 87: 149-50.
Oto A, Tokgozoglu SL, Oram A, et al. Late percutaneous extraction of an intracardiac catheter fragment. Jpn Heart J 1993; 34: 117-9.
Thanigaraj S, Panneerselvam A, Yanos J. Retrieval of an IV catheter fragment from the pulmonary artery 11 years after embolization. Chest 2000; 117: 1209-11.
Schüler S, Hetzer R, Stegmann T, et al. Surgical therapy of intracardiac infected pacemaker electrodes and catheter remnants. Z Kardiol 1986; 75: 151-5.
Richardson JD, Grover FL, Trinkle JK. Intravenous catheter emboli. Experience with twenty cases and collective review. Am J Surg 1974; 128: 722-7.
Huggon IC, Qureshi SA, Reidy J, et al. Percutaneous transcatheter retrieval of misplaced therapeutic embolisation devices. Br Heart J 1994; 72: 470-5.
Massumi RA, Ross AM. Atraumatic, nonsurgical technic for removal of broken catheters from cardiac cavities. N Engl J Med 1967; 277: 195-6.
Hartnell GG. Homemade snare for removal of foreign bodies. Radiology 1991; 181: 903-4.
Curry JL. Recovery of detached intravascular catheter or guide wire fragments. A proposed method. Am J Roentgenol Radium Ther Nucl Med 1969; 105: 894-6.
Richardson JD, Grover FL, Trinkle JK. Intravenous catheter emboli. Experience with twenty cases and collective review. Am J Surg 1974; 128: 722-7.
Kohli V, Joshi R. Central line retrieval in a neonate. Indian J Pediatr 2007; 74: 692-3.
Dawson S, Papanicolaou N, Mueller PR, et al. Preserving access during percutaneous catheterization using a double-guide-wire technique. AJR Am J Roentgenol 1983; 141: 407.
Strohmer B, Altenberger J, Pichler M. A new approach of extracting embolized venous catheters using a large-diameter steerable sheath under biplane fluoroscopy. Clin Imaging 2012; 36: 502-8.
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