Endovascular catheter knot untying: A new technique

Erik Soule

doi:10.33118/oaj.radiol.2019.01.002

Abstract

Indwelling vascular catheters may be maintained for extended periods of time especially for critically ill or hospitalized patients requiring frequent blood draws. If they become knotted within the vasculature, serious iatrogenic sequelae can result, such as: pneumothorax, atrial arrhythmias, ventricular arrhythmias, pulmonary embolism, pulmonary hemorrhage, intracardiac rupture, pulmonary artery rupture, balloon rupture, bacteremia, and death. Surgical cut-down may be indicated for removal of knots that preclude catheter retrieval and are refractory to intravascular removal modalities. Three such knots were untied using the intraluminal technique described in this report. The technique utilizes balloon angioplasty in conjunction with a wire to safely and effectively untie knotted catheters. Keywords: Vascular catheters, Arrhythmias, Angioplasty balloon.

Highlights

Intravascular knot formation was first described by Johansson in 1954 [1]
If they become knotted within the vasculature, serious iatrogenic sequelae can result, such as: pneumothorax, atrial arrhythmias, ventricular arrhythmias, pulmonary embolism, pulmonary hemorrhage, intracardiac rupture, pulmonary artery rupture, balloon rupture, bacteremia, and death
After the knot was untied intravascularly, the SG catheter was withdrawn in its entirety without incident from the right subclavian vein (Figure 5)

Summary

Introduction

Often going unrecognized until it is time to remove the device, intravascular knots can preclude retrieval of indwelling catheters. Both surgical and non-surgical methods have been described for the removal of knotted catheters and wires [2]. This report describes a technique utilizing an angioplasty balloon to untie such knots This technique has been employed to safely and effectively untie and remove three separate knotted catheters. The knot was fully untied by reintroducing the Glidewire into the SG catheter through the subclavian vein access. After the knot was untied intravascularly, the SG catheter was withdrawn in its entirety without incident from the right subclavian vein (Figure 5).

Discussion

Conclusion