Catheter Fragment Research Articles

Flailed tricuspid valve as a complication of retrieving fractured catheter

The implantable venous port system has gained popularity as venous access when prolonged chemotherapy is needed in cancer patients. Intravascular fracture and embolization of catheter fragments from port-catheter systems is rare. Here we report a 49-year-old lady who was found having a fractured port-catheter located over the right ventricular outflow tract (RVOT). Percutaneous transfemoral transcatheter retrieval of the fractured catheter was performed but complicated with flailed tricuspid valve.

Percutaneous Retrieval of Misplaced Intravascular Foreign Objects with the Dormia Basket: An Effective Solution

We report our experience of the retrieval of intravascular foreign body objects by the percutaneous use of the Gemini Dormia basket. Over a period of 2 years we attempted the percutaneous removal of intravascular foreign bodies in 26 patients. Twenty-six foreign bodies were removed: 8 intravascular stents, 4 embolization coils, 9 guidewires, 1 pacemaker lead, and 4 catheter fragments. The percutaneous retrieval was achieved with a combination of guide catheters and the Gemini Dormia basket. Percutaneous retrieval was successful in 25 of 26 patients (96.2%). It was possible to remove all the intravascular foreign bodies with a combination of guide catheters and the Dormia basket. No complication occurred during the procedure, and no long-term complications were registered during the follow-up period, which ranged from 6 months to 32 months (mean 22.4 months overall). Percutaneous retrieval is an effective and safe technique that should be the first choice for removal of an intravascular foreign body.

Percutaneous removal of two intracardiac and pulmonary trunkal catheter fragment by using a snare-loop catheter

Endoluminal retrieval of foreign bodies in the cardiac laboratory is an uncommon and challenging procedure for the endovascular specialist, and its only alternative is an open exploration. The availability of smaller catheter systems allows retrieval with minimally invasive techniques. We report retrieval of two catheter fragments using a snare-loop catheter through the femoral vein.

Massive Pulmonary Embolism in Pregnancy Treated with Catheter Fragmentation and Local Thrombolysis

Massive Pulmonary Embolism in Pregnancy Treated with Catheter Fragmentation and Local Thrombolysis

Cateteres intravenosos fraturados: retirada por técnicas endovasculares

OBJETIVO: A colocação de cateter para acesso venoso central é uma prática médica cada vez mais comum, sendo a fratura e embolização de fragmentos do cateter raras, porém correspondem aos corpos estranhos intravasculares mais comuns. O objetivo é demonstrar nossa experiência na retirada desses corpos estranhos intravasculares utilizando técnicas endovasculares. MATERIAIS E MÉTODOS: Análise retrospectiva dos últimos cinco anos permitiu a avaliação de dez casos consecutivos, com a idade variando entre nove meses e 67 anos. RESULTADOS: O procedimento foi realizado com sucesso em todos os casos, por diferentes técnicas, sem complicações. Os locais mais comuns de alojamento dos fragmentos foram átrio direito, veia cava superior e artéria pulmonar esquerda. A retirada desses corpos estranhos por técnicas endovasculares é procedimento relativamente simples quando comparado à alternativa cirúrgica, tendo sido utilizada com segurança e sucesso em inúmeros pacientes. Os dispositivos disponíveis mostraram-se bastante eficazes, sendo o laço o mais versátil. CONCLUSÃO: A alta taxa de sucesso com poucas complicações relatadas, mesmo em crianças, permite a afirmação que os corpos estranhos intravenosos devem ser extraídos por técnicas percutâneas sempre que possível. Contudo, a familiarização com as diversas técnicas é fundamental, permitindo combinações e modificações, adaptando-as à situação do caso.

Transcatheter Retrieval of Different Types of Central Venous Catheter Fragment: Experience in 13 Cases

In total, 13 patients, from April 1992 to November 2002 at this institution, had embolization caused by central venous catheter fragments including 4 peripherally-inserted central catheters (PICCs), 1 Hickman catheter, 1 Swan-Ganz catheter, and 7 port-A catheters. These dislodged fragments were percutaneously retrieved successfully in 12 patients. As each type of the central venous catheter has its distinct properties, the locations of embolization, detection, and retrieval methods differed.

Subcutaneous effusion resulting from an epidural catheter fragment

The breakage of an epidural catheter within a patient is uncommon, but troublesome, complication of epidural block, and its cause is rarely discovered. In this case report, our aim was to present an effusion between s.c. tissue and fascia in the lumbar region because of a broken fragment of epidural catheter which was unnoticed during its removal.

Atypical pulmonary embolism of port catheter fragments in oncology patients

Embolization of venous catheter fragments to the pulmonary vasculature is a very rare form of pulmonary embolism which is only sporadically reported in the literature. The incidence and clinical picture of this complication are unknown. In this retrospective analysis between 1999 and 2004, in our clinic, 1,014 port catheters were implanted. In this 5-year period, the patients' files were screened for the incidence of pulmonary embolism of catheter fragments and the accompanying complication rate. In 11 patients, port catheter dislodgment and embolism into the pulmonary artery occurred. In all the patients' port examination by fluoroscopy, catheter dislocation and embolization were shown. In these 11 patients, no obvious clinical signs indicating dislocation of catheter fragments into the pulmonary circulation were found. None of these patients demonstrated respiratory symptoms. Heart rate, blood pressure, respiration frequency, and even oxygen saturation were normal. In 7 of the 11 patients, malfunction of port catheter was the first indicator of catheter dislocation. In four patients, embolized catheter fragments were an incidental finding. The main cause of catheter embolization was the pinch off syndrome. All embolized catheter fragments were retrieved by a 'goose-neck' snare without complication. These results suggest that the migration of fractured catheter into the pulmonary artery occurs in 1% of the central port catheter implantation. It is often asymptomatic, and malfunction of the catheter may be the first sign of this complication. The pinch off syndrome might be prevented by using the internal jugular vein or by implantation of the port catheter more laterally in the subclavian vein.

Transluminal Removal of a Fractured and Embolized Indwelling Central Venous Catheter in the Pulmonary Artery

Vascular catheters are associated with complications such as infection, thrombosis and stenosis. The embolization of a venous catheter fragment is a rare complication. A 39-year-old woman underwent placement of a totally implantable venous access device for chemotherapy to treat a recurrent liposarcoma of the left thigh. The "pinch-off sign" was noted on a routine chest X-ray but that was ignored. Three-months after implantation of the intravenous access device, the indwelling central catheter was fractured and embolized to the pulmonary trunk. The catheter in the pulmonary trunk was successfully removed through a percutaneous femoral vein approach using a pigtail catheter and goose neck snare.

Acrylic cement pulmonary embolus masquerading as an embolized central venous catheter fragment

An acrylic cement pulmonary embolus is a rare complication of percutaneous vertebroplasty. Many patients remain completely asymptomatic, but others may present with chest discomfort, dyspnea, and even cardiovascular collapse leading to death. Here we present an asymptomatic patient initially thought to have a central venous catheter pulmonary artery embolus based on the morphology of the foreign body on imaging exams. A more thorough investigation established the diagnosis of an acrylic cement pulmonary embolus resulting from percutaneous vertebroplasty procedures performed many months before the embolus discovery. The diagnostic work-up, treatment strategy, and a review of the literature are presented.

An alternative technique for totally implantable central venous access devices. A retrospective study of 1311 cases

Aim The aim of the present study was to report our experience of totally implantable central venous access devices (TICVAD) implantation using two techniques and attempt to define the better technique. Materials and methods From January 1998 to September 2003, 1131 patients were reviewed and divided into two groups with implantation by cephalic vein cut-down (group A) done by general surgeons and subclavian vein puncture with the Seldinger technique (group B) done by vascular surgeons. The operative time, early and late complications of these two groups were compared. Data were analysed by Student's t-test. Results The average of operative time was 43 min in group A (35—70 min) and 40 min in group B (35—60 min) ( P>0.05). No post-operative pneumothorax, hemothorax and fragmentation occurred in group A; the incidence of peri-operative complication was higher in group B. The overall and early complications of group A were significantly lower than that of group B ( P<0.0001). Conclusion This retrospective study showed that the cephalic vein cut-down approach for TICVAD placement avoided the risks of pneumothorax, hemothorax and catheter fragmentation.

Massive Pulmonary Embolism in Pregnancy Treated With Catheter Fragmentation and Local Thrombolysis

Catheter-directed thromboembolus fragmentation and thrombolysis is used with success for treatment of pulmonary embolism with hemodynamic decompensation in nonpregnant patients, but information on its use during pregnancy is limited. We report successful treatment of massive bilateral pulmonary emboli in the third trimester of pregnancy. A 29-year-old multigravida at 30 weeks of gestation presented with dyspnea, chest pain, heart palpitations, and syncope. A computed tomographic angiogram demonstrated massive bilateral central pulmonary emboli. Despite heparin and oxygen therapy, aggressive fluid resuscitation and pressor treatment, hypotension persisted, and there were prolonged, deep fetal heart rate decelerations. Emergency percutaneous pulmonary artery catheter thrombus fragmentation, followed by local infusion of tissue plasminogen activator, was performed. The patient recovered rapidly and was discharged from the hospital on subcutaneous low-molecular-weight heparin. She was delivered of a normal, healthy infant at term. Catheter-directed mechanical fragmentation and local thrombolytic infusion therapy is a treatment option for pulmonary embolism with hemodynamic decompensation in pregnancy. Advantages are rapid clot lysis with consequent return of normal hemodynamics and uterine perfusion and avoidance of systemic thrombolytics and associated risk of bleeding complications.

Intravascular Catheter Fragment: A New Method for Percutaneous Removal

Intravascular Catheter Fragment: A New Method for Percutaneous Removal

Percutaneous retrieval of intravascular broken catheter fragments. A novel technique using a balloon.

We describe a novel technique to retrieve broken catheter fragments from the vascular tree at difficult locations using a balloon. A coronary balloon can be taken over a microwire into the catheter fragment to hold it after inflation of the balloon and then the whole assembly can be gradually taken out. We used this novel technique successfully in three patients where the snare failed to retrieve the broken catheter fragment from vascular tree.

Approach to Fragmented Central Venous Catheters

Prolonged venous access devices are needed in cancer patients for central venous access. Catheter fragmentation leading to catheter malfunction represents a rare problem. Herein we present our experience in the management of fragmented catheters. Between 2001 and 2003, 183 catheters were placed via the subclavian vein, and five cases of fragmented catheters were observed. Fragments were removed by an Amplatz gooseneck snare (Microvena, St. Paul, MN) with angiographic intervention. The diagnosis of the breakage was made by chest radiography. The incidence of catheter breakage was 2.7%. All fragments were removed by the snare, without any complications. Catheter narrowing and breakage owing to its medial positioning in the subclavian vein were the main causes of catheter malfunction. In any case of catheter malfunction, radiologic evaluation of the catheter must be done to rule out its rupture. Removal of the fragments using the Amplatz snare is a safe and easily applied procedure.

Detectability of Catheters on Bedside Chest Radiographs: Comparison between Liquid Crystal Display and High-Resolution Cathode-Ray Tube Monitors

To compare observer performance with a flat-panel liquid crystal display (LCD) monitor and with a high-resolution gray-scale cathode-ray tube (CRT) monitor in the detection of simulated support catheters on bedside chest radiographs. The ethics committee did not require approval or patient informed consent when this study began. Because of a change in regulations, before images were acquired the nature of the study and procedures were explained to patients or their relatives, and consent was then obtained. A total of 131 catheter fragments (12-14 per radiograph) were superimposed over 10 anteroposterior bedside chest radiographs obtained with storage phosphor technology. Images were displayed on an LCD monitor (1536 x 2048 matrix) and a CRT monitor (2048 x 2560 matrix). Five radiologists independently located the catheter fragments and rated their confidence in detection with bright and subdued ambient light. A two-way analysis of variance and the Friedman test were used for statistical analysis. There was no significant difference for either display type with respect to correctly detected catheter fragments (mean sensitivity, 56.6% and 56.0% for the CRT and the LCD monitors, respectively, with bright light and 61.2% for both monitors with subdued light). With both display types, detection rate with bright light decreased significantly (P < .05). False-positive rates and confidence ratings were not significantly affected by monitor type or ambient light. In a study with simulation of clinical conditions, performance of the LCD monitor and high-resolution CRT monitor for detection of support catheters on bedside chest radiographs was equivalent. With both displays, detection performance was equally reduced with bright ambient light.

Neonatal bronchial obstruction caused by aspiration of placental tissue

The patient was a 3,140-g male born at 38 weeks gestation to a 40-yearold gravida 2, para 2 mother. A caesarean section was performed because of prior uterine scar and poly-leiomyomatous uterus; the delivery was extremely difficult. The Apgar scores were 3, 8 and 8 at 1, 5 and 10 min, respectively. Positive pressure ventilation was attempted by bag and mask. A thoracoabdominal radiograph demonstrated mediastinal shift to the left, an opaque left hemithorax, an anterior right pneumothorax and a pneumomediastinum (Fig. 1). He was intubated orally and high-frequency oscillatory ventilation commenced. A suction catheter introduced through the endotracheal tube brought back a fragment of purple soft tissue measuring 1·0.6 cm. His respiratory status improved and the left lung re-aerated. Histological examination revealed the inhaled fragment to be of placental origin.Neonatal aspiration is usually related to amniotic fluid or meconium-stained fluid. Foreign body aspiration is very rarely encountered in neonates. Aspiration of a fragment of suction catheter [1] and aspiration of decidua [2] have previously been reported. The diagnosis of tracheobronchial obstruction secondary to placental fragment aspiration may be considered in neonatal respiratory distress after caesarean section and arduous delivery.

Endoluminal Retrieval of a Dislodged Umbilical Vein Catheter

Endoluminal retrieval of foreign bodies in the pediatric and infant population is an uncommon and challenging procedure for the endovascular specialist. The alternative is an open exploration of these often-fragile patients. The availability of smaller catheter systems allows retrieval with minimally invasive techniques. We report retrieval of a catheter fragment using an Amplatz loop snare through the umbilical vein and review the literature.

Endovascular foreign objects retrieved by interventional radiologists at Universitas Hospital

During the past 4 years, 15 patients have undergone intravascular removal of foreign bodies — 9 central venous line fragments, 3 guidewires, 2 pacemaker leads and 1 misplaced embolisation coil. Ten foreign bodies (including 2 guidewires, 2 pacemaker leads and 6 central venous catheter fragments) were recovered from the big veins and right heart, 3 (central venous line fragments) from the pulmonary arterial system and 2 (an embolisation coil and a guidewire) from the arterial system. The percutaneous removal of foreign bodies is efficient with few complications. Surgery should only be considered for patients in whom removal attempts with endovascular interventional techniques have failed.

Delayed Migration of a Catheter Fragment from the Left to the Right Pulmonary Artery

A 45-year-old woman is described in whom an intrapulmonary venous access catheter fragment, originally left in place when discovered 1 year after port removal, migrated from one side to the other 2 years later. The patient underwent uncomplicated percutaneous removal of the fragment via the right internal jugular vein. The observed fragment mobility adds further argument for removing all intravenous catheter fragments, even if they have embolized to the pulmonary artery.