Entrapment of modified Simmonds catheter by aortic valve using turn-over technique. A case report

Abstract

BackgroundTurn-over technique of Simmonds catheter by aortic valve is widely used not only for diagnostic transradial cerebral angiography (TRA), but transfemoral endovascular treatment for patients who has a difficulty of catheter access to cerebral arteries. We herein report a rare complication of entrapment of modified Simmonds catheter using turn-over technique with aortic valve that was assumed that the catheter passed through the fenestrated aortic valve and were entrapped to become difficult to remove. Case descriptionA 66-year-old woman underwent diagnostic TRA. A 4Fr modified Simmonds catheter was advanced to the ascending aorta under fluoroscopic guidance. A guidewire was turned over at the aortic valve to form a modified Simmonds catheter shape. The catheter was stuck when pulled to be hooked on the major aortic bifurcation. The Simmonds catheter was finally withdrawn and removed using supportive stiff wire. Transthoracic echocardiography performed after the procedure revealed jet-like leaking between the cusps, suggesting fenestration of the aortic valve. It is assumed that the catheter was entrapped by the aortic valve because the guidewire accidentally passed through the small fenestrated aortic valve that had already existed and the catheter was advanced through the fenestrated aortic valve. ConclusionWe experienced a rare technical pitfall of entrapment of modified Simmonds catheter by aortic valve using turn-over technique. Clinicians should be aware of a rare complication may occur during endovascular intervention.