Gooseneck Snare Research Articles

Exploring ways to remove the double J tube fluoroscopically from ureter

Objective To investigate the feasibility and safety of the double J tube removal from ureter under fluoroscopy observation. Methods The medical records of patients in our department from April 2013 to March 2015, who performed double J tube removal and/or replacement were retrospectively reviewed and analyzed. These data included gender and age of the patient, position of the double J tube end in the bladder, removal method, fluoroscopy time, postoperative complications and so on. The removal methods were divided into a direct method and an indirect method. The direct method means using the ring of a gooseneck snare to hitch directly the end of double J tube in the bladder, and pulling it to the urethral orifice. For the indirect method, a guide wire and a gooseneck snare first were sent into the bladder to clip the double J tube, then, the ring of the gooseneck snare was used to hitch the end of the guide wire to withdraw the gooseneck snare and the guide wire to the urethral orifice, and the double J tube was pulled to the urethral orifice. The double J tube end position in the bladder had direct relationship with the choice of removal method. The author divided the double J tube end position in the bladder into A type, B1 type, B2 type, and C type. The bladder was divided into four quarters equally. Direct method was suitable for all types, while indirect method was only suitable for B2 and C type. Between April 2013 and September 2014, all patients were treated by the direct method; between October 2014 and March 2015, all patients with B1 and A type were treated by the direct method, and all patients with B2 and C type were treated by the indirect method. According to the success rate of operation, fluoroscopy time, the incidence of different complications, the efficacy and safety were determined. Results This study recruited a total of 49 patients, including 6 males and 43 females, who underwent 114 times of double J tube removal. On average, double J tube was removed 2.3 times per case. The overall success rate was 96.5% (110/114). The application of direct method was 92 times, and the success rate was 95.7% (88/92). The application of indirect method was 22 times, and the success rate was 100% (22/22). In this study, there were 4 failures to remove the double J tube, all of which happened in the direct method for the C type of patients. In the successful 110 cases, the average fluoroscopy time was (11.3+9.5) min. The application of direct method was 88 times, and the average fluoroscopy time was (12.3±10.3) min; the application of indirect method was 22 times, and the average fluoroscopy time was (7.6±3.8) min. There were 10 cases with pain in urethral orifice, in which 9 cases was treated with direct method and one with indirect method. There were 5 cases with gross hematuria complicated in direct method. The overall incidence rate of the complications was 13.2% (15/114). All of postoperative complications resolved spontaneously. Conclusion The direct way and the indirect way to remove ureteral double J tube fluoroscopically are feasible and safe. Key words: Ureteral obstruction; Fluoroscopy; Classification

Goose-neck snare-assisted transcatheter ASD closure: A safety procedure for large and complex ASDs.

To report on a new technique that increases the safety of percutaneous atrial septal defect (ASD) closure using a goose-neck snare system. ASD transcatheter closure is a widespread procedure. However, in some cases, ASDs may be large and with soft rims. In these situation, a potential risk exists for device malposition or embolization. When transesophageal echocardiography (TEE) evaluation and balloon sizing showed large defects with floppy rims the chosen Amplatzer device was implanted in a standard way. In large defects with floppy rims, before release a 5-mm goose-neck snare with its 4 Fr catheter was placed across the delivery cable and fixed to catch the screwing mechanism of implanted Amplatzer device. The delivery cable was unscrewed and the device reached its final position without any tension. If the position was considered satisfactory the device was released from the goose-neck snare. Thirteen patients had a snare-assisted ASD transcatheter closure. Median device size was 24 mm (range 14-38 mm). Retrieval or repositioning of the device using the goose-neck snare was performed in four cases: in three patients, because of device malposition after delivery cable release and in one patient, because of unsuitability of closure of a second significant defect. Furthermore, in two subjects with multiple ASDs, a second fenestration looked quite significant with the device still attached to the delivery cable while it appeared smaller after release. Snare-assisted Amplatzer ASD device placement is a new method for ASD percutaneous closure and adds safety to the procedure.

Modified Technique to Create Diabolo Stent Configuration.

Diabolo stent configuration aids in stent positioning, stability, and creating a controlled defect with a predetermined size. A number of techniques to create the diabolo configuration have been previously described. The indications for creating a controlled "defect" are rapidly growing and include the Fontan circulation, patients with severe end-stage pulmonary hypertension, restrictive atrial communication in the setting of hypoplastic right or left heart syndrome, and diastolic left heart failure. We describe an alternative technique using a prefabricated readily available tool (gooseneck snare) to create a diabolo stent configuration. The chosen balloon expandable stent is mounted on a 5-mm gooseneck snare centered on an angioplasty catheter larger than 5 mm diameter. When deployed, the snare restricts the central waist to 5 mm and both ends expand to a larger diameter creating a dumbbell/diabolo configuration. A total of six diablo stent configurations were successfully implanted in four patients with failing Fontan physiology; five to create a transcatheter fenestration and one to relieve atrial septal restriction. Data expressed as median and IQR. Their weight was 24.8 kg (19.6-46.95), and age years was 9.2 (6.28-13.23). There were no complications and a consistent diabolo configuration with a 5-mm central waist was created in all patients. The snare serves as a sterile, preconfigured, radiopaque, readily available tool of adequate length and strength, to create consistent diabolo stent configuration without any modifications. This technique is a simple, reproducible, and easy to learn.

Transvenous Lead Extraction via the Inferior Approach Using a Gooseneck Snare versus Simple Manual Traction.

Background and ObjectivesThe number of patients with cardiac implantable electronic devices needing lead extraction is increasing for various reasons, including infections, vascular obstruction, and lead failure. We report our experience with transvenous extraction of pacemaker and defibrillator leads via the inferior approach of using a gooseneck snare as a first-line therapy and compare extraction using a gooseneck snare with extraction using simple manual traction.Subjects and MethodsThe study included 23 consecutive patients (43 leads) who underwent transvenous lead extraction using a gooseneck snare (group A) and 10 consecutive patients (17 leads) who underwent lead extraction using simple manual traction (group B). Patient characteristics, indications, and outcomes were analyzed and compared between the groups.ResultsThe dwelling time of the leads was longer in group A (median, 121) than in group B (median, 56; p=0.000). No differences were noted in the overall procedural success rate (69.6% vs. 70%), clinical procedural success rate (82.6% vs. 90%), and lead clinical success rate (86% vs. 94.1%) between the groups. The procedural success rates according to lead type were 89.2% and 100% for pacing leads and 66.7% and 83.3% for defibrillator leads in groups A and B, respectively. Major complications were noted in 3 (mortality in 1) patients in group A and 2 patients in group B.ConclusionTransvenous extraction of pacemaker leads via an inferior approach using a gooseneck snare was both safe and effective. However, stand-alone transvenous extraction of defibrillator leads using the inferior approach was suboptimal.

Successful interventional recanalization against heavily calcified chronic total occlusion of proximal right coronary artery utilizing retrograde guidewire trapping technique at the terminal aorta

We described a case of chronic total occlusion (CTO) of the ostial right coronary artery (RCA) in a 79-year-old woman that had been undergoing hemodialysis. Coronary intervention of the ostial RCA-CTO was performed via the retrograde approach. The retrograde hard wire was able to pass through the CTO segment via a transseptal collateral and advanced at the ascending aorta. However, the microcatheter tip could not advance into the heavily calcified plaque of the CTO segment. Moreover, it was very difficult to catch the retrograde hard wire tip in the ascending aorta using a 10mm Gooseneck snare at the ostium of the antegrade guiding catheter due to three-dimensional size mismatch. Thereby, we attempted to cross the occluded segment directly using a long-shaft soft guidewire designed for retrograde CTO intervention (0.009 inch 330 cm). The unassisted long-shaft wire tip was passed successfully through the CTO segment retrogradely. After the retrograde wire tip was pushed ahead of the terminal aorta, it was caught using the former snaring system, and another guiding catheter for the antegrade approach was pulled in. After wire externalization was completed, balloon dilatation and stent deployment through the CTO segment were performed successfully via the antegrade approach. Here, we report a case of successful interventional revascularization of a heavily calcified and device-uncrossable CTO lesion by the retrograde wire trapping technique using a gooseneck snare device at the terminal aorta. The method in which the capture of a retrograde wire using Gooseneck snare system may be not novel in itself. But, in case of difficulty in uncrossability devices and catching it at the ascending aorta as well, this combinative technique is beneficial to the ease of wire externalization.

Successful Retrieval of a Dismembered Central Venous Catheter Stuck to the Right Pulmonary Artery Using a Stepwise Approach.

Recent advances in anticancer chemotherapy have resulted in an increase in the number of patients requiring a central venous port catheter, and the incidence of catheter pinch-off syndrome has been increasing. Catheter pinch-off syndrome is a rare and unusual complication. It is difficult to retrieve dislodged catheters from the pulmonary artery, especially if the catheter is stuck to the peripheral pulmonary artery. We herein describe the successful removal of a catheter stuck in the pulmonary artery with a stepwise approach. First, a pigtail catheter was used to tug the dislodged catheter in order to free the unilateral end. Then, a gooseneck snare was used to catch and pull the catheter out of the patient. The key to success is to free the end of the catheter.

The successful retrieval of a broken guide wire from the diagonal branch of the left anterior descending coronary artery complicated by partial stent rolling.

Percutaneous coronary interventions (PCIs) are relatively safe, and the complication rate is low in comparison to cardiac surgery revascularization. The incidence of broken or retained PCI equipment is about 0.1–0.8% [1]. We report a successful retrieval of a fractured guide wire by using a percutaneous catheter Amplatz GooseNeck Snare and Microsnare Kit (Covidien, Plymouth, USA), which was complicated by stent deformation in the form of rolling up its distal part after retracting a piece of the guide wire. This artificial damage to the implanted stent was initially ineffectively treated with balloon angioplasty and finally successfully with double drug-eluting stent (DES) deployment.

Getting the LV lead to the right spot.

Getting the LV lead to the right spot.

Starfix lead extraction: Clinical experience and technical issues

Transvenous lead extraction (TLE) of the Starfix coronary sinus (CS) active-fixation lead may be challenging, due to undeployment of fixation lobes and venous occlusion. We report our experience in Starfix TLE, in comparison with previous data.A 78-year-old male, implanted in 2009 with Starfix lead, was referred to our institution for TLE, due to infective endocarditis with lead-associated vegetations. The tip of Starfix lead was located in distant, anterior position, in the great cardiac vein, close to patent left internal mammary artery-to-left anterior descending artery anastomosis, and first-choice surgical removal had a prohibitive operative risk.Conventional dilatation beyond CS ostium, as well as the use of a standard delivery catheter, was ineffective. An off-label modification of the delivery, by cutting the distal soft tip, was successful. However, the tip of the lead fragmented and was trapped in the innominate vein. Then a gooseneck snare grasped the fragment, allowing complete retrieval.TLE of Starfix leads may be particularly challenging, especially when its tip is located in a distant anterior location. In these cases, important help may be obtained by dilatation within the CS, by means of conventional or modified delivery catheters. Only experienced operators, sometimes with non-conventional techniques, should perform TLE of Starfix leads.<Learning objective: TLE of Starfix leads may be challenging, particularly when the tip is located in a distant anterior position. Dilatation with conventional tools may be precluded. In these cases modifications of the delivery catheters may be useful. Surgery should be avoided as first-choice procedure; only experienced operators, sometimes with non-conventional techniques, should perform TLE of Starfix leads.>

55 A Highly Effective Technique for Transseptal Endocardial Left Ventricular Lead Placement for Delivery of Cardiac Resynchronisation Therapy

Introduction Endocardial transseptal left ventricular (LV) lead delivery is challenging due to the absence of dedicated equipment designed for this procedure. We describe a new technique for delivery of a transseptal LV lead. Methods Patients (pts) with class 1 indication for CRT and a previous failed attempt at conventional LV lead placement via the coronary sinus were offered this procedure. All pts were anticoagulated with Warfarin. The implantation technique is shown in the Figure 1. A left subclavian and right femoral venous access are initially obtained. A: a gooseneck snare (a) is opened in the right atrium (RA) through which an Endry’s needle and Mullin’s sheath (b) are advanced into the RA. B: a transseptal puncture is made and a wire is placed in the left upper pulmonary vein. C: the snare is advanced into the left atrium (LA) and an Attain sheath is advanced over the snare. D: the snare is removed leaving the Attain sheath in the LA. E: an active fixation lead is advanced through the sheath into the LV and screwed into the lateral wall. The sheath is split and removed F: all three LV leads are seen: (c) a previous transvenous lead, (d) a surgical epicardial lead and (e) the new active fixation lead. Results The procedure was performed successfully in all 12 pts attempted. The median procedure and fluoroscopy time were 148 min (IQR 113–176) and 16 min (IQR 10–19). Endocardial LV lead electrical parameters were satisfactory at implant and stable over time. The only complication was a pocket haematoma in a pt with a sub-pectoral generator. There was no need for repeat procedures after a median follow-up of 97 days (IQR 36–250). Conclusions This approach provides a reliable and effective alternative technique for delivery of an endocardial LV lead inserted transseptally into the LV.

PP-136 Succesful Transumbilical Retrieval of A Broken Umbilical Artery Catheter in a 1000 gm Premature Newborn

Umbilical artery catheterization has become the standard of care for arterial access in neonates, and also leads to wide spectrum of complications. Broken and embolised catheter fragments had been rarely reported in these patients. We report a case of successful transumbilical retrieval of a broken umbilical arterial catheter with a gooseneck snare catheter under fluoroscopic guidance in a 28-week gestation, 1000 gm male infant.

A highly effective technique for transseptal endocardial left ventricular lead placement for delivery of cardiac resynchronization therapy.

Implantation of a left ventricular (LV) lead fails in 5% to 10% of patients in whom cardiac resynchronization therapy (CRT) is attempted. Alternatives for delivery of CRT are surgical epicardial and endocardial transvenous leads. Endocardial transseptal LV lead delivery is challenging because of the absence of dedicated equipment designed for this procedure. The purpose of this study was to describe a new technique for delivery of a transseptal LV lead. This dual approach from the right femoral vein and left subclavian vein involves use of an Endrys transseptal needle and Mullins sheath to deliver a gooseneck snare from the left subclavian vein into the right atrium that can then be used to deliver a deflectable sheath into the left atrium. An active fixation lead is advanced into the LV through the sheath and screwed into the lateral wall. The procedure was performed successfully in 12 patients in whom transvenous LV lead implantation had previously failed. The Endrys transseptal needle, ideally suited for this technique, facilitated passage of the gooseneck snare into the left atrium with no difficulty. Median procedure time was 148 minutes (interquartile range [IQR] 113-176 minutes), and median fluoroscopy time was 16 minutes (IQR 10-19 minutes). There was no need for repeat procedures after median follow-up of 97 days (IQR 36-313 days). This approach using an Endrys needle and a gooseneck snare provides a reliable and effective alternative technique for delivery of an endocardial LV lead that is delivered easily through a deflectable sheath inserted transseptally into the LV.

Ventricular tachycardia from embolized central venous port

Central venous access is typically required for prolonged administration of intravenous medications. Implantable ports are most frequently used in cancer chemotherapy. The spontaneous fragmentation and embolization of these catheters is not uncommon and can present rare but potentially life-threatening complications such as ventricular tachycardia (VT). We present an adolescent with a 2-week history of intermittent VT unrelated to activity. A chest x-ray confirmed spontaneous fragmentation of the central line and embolization in the right ventricle and pulmonary artery. Successful retrieval of the embolized catheter was performed without any complications using the gooseneck snare technique and the patient was free of symptoms at follow up. Chest x-rays can be beneficial in ruling out other causes of VT and in avoiding unnecessary treatment or management.

Mechanical embolectomy for acute ischemic stroke in the anterior cerebral circulation: the Gothenburg experience during 2000-2011.

Intra-arterial treatment of proximal occlusions in the cerebral circulation have become an important tool in the management of acute ischemic stroke. Our goal was to evaluate the safety and efficacy of intra-arterial acute ischemic stroke treatment performed in our institution in consecutive patients with anterior circulation occlusion during 2000-2011. We identified, in our data base, 156 consecutive cases with anterior acute ischemic stroke treated intra-arterially during 2000-2011. Stroke severity was defined according to the National Institutes of Health Stroke Scale, the results of the procedure were defined according to the modified Thrombolysis in Cerebral Infarction score, and clinical outcome was defined according to the modified Rankin scale, with favorable outcome ≤2 at 90 days. The mean admission NIHSS score was 19.4 (median, 20), with a mean time from stroke onset to groin puncture of 197 minutes (median, 171 minutes). The embolectomy tool of choice was the Amplatz GooseNeck snare (83%). Successful recanalization (modified TICI 2b +3) was seen in 74% of cases. A mRS ≤ 2 at 90 days was seen in 42% with a mortality rate of 17% and symptomatic intracerebral hemorrhage in 4%. A high recanalization rate was obtained with the Amplatz GooseNeck snare without any device-related complications. Favorable outcome, mortality, and symptomatic intracerebral hemorrhage are comparable with results of newer embolectomy devices.

Percutaneous retrieval of PICC fractures via the femoral vein in six cancer patients.

To investigate the feasibility and safety of the interventional technique of retrieving the fractured peripherally inserted central catheter (PICC) segments within the vessels via the femoral vein. From July 2007 to January 2012, we performed percutaneous retrieval of PICC fractures in six cancer patients who accepted chemotherapy via PICC. The fractures occurred during the traction of the catheter and were diagnosed with chest plain film radiography and/or computed tomography. The patients included four cases of ovarian cancer, one case of breast cancer and one case of cervical cancer. The fractures were retained in the vessels of the patients for 1 to 10 days. According to the location of the ends of the PICC fractures, three methods were employed using the most commonly used interventional devices in the digital subtraction angiography suite. The PICC fractures were located in the subclavian vein, superior vena cava, right atrium, right ventricle or pulmonary arteries. During the procedures, a goose neck snare, pigtail catheter and stone basket catheter were used individually or in combination. The PICC fractures were removed successfully in all six patients via unilateral or bilateral femoral vein access. No major complications occurred during the operation or the follow-up period of 7 to 10 days. Via femoral vein access, PICC fractures could be removed with common interventional instruments such as a goose snare, basket catheter and pigtail catheter. The interventional retrieval is a safe, convenient and minimally invasive method for the removal of PICC fractures.

A case of guidewire embolism during central venous catheterization: Better safe than sorry!

Sir, Central venous catheterization (CVC) is a routine procedure in intensive care unit as well as in surgical patients requiring monitoring of hemodynamic variables, for medications and parentral nutrition, hemodialysis etc. The incidence of complications ranges from 5% to 29%[1] such as arterial puncture, hemothorax, pneumothorax, nerve injury, air embolism or dysrthythmias. Guidewire embolism during CVC is a rare iatrogenic complication.[2] The Seldinger technique is commonly used to cannulate the vessels.[3] We report a case of lost guidewire following internal jugular catheter placement and its successful management. A 64-year-old male, weighing 67 kg, 176 cm height had c/o hematuria since last 15 days. Patient was suffering from chronic obstructive pulmonary disease, diabetes and hypertension. Ultrasound showed bladder mass lesion, enlarged prostate, and hepatomegaly. His serum creatinine was 5.07 mg/dl, total cholesterol-18,170/cmm, serum glutamic-pyruvic transaminase-122.0 and serum glutamic oxaloacetic transaminase-118.0. In view of acute renal failure and septicemia, CVC for fluid management and drug administration was advised. During a busy night shift, a 2nd year resident was assigned to perform the procedure. The left internal jugular vein was cannulated using double lumen (Polymed Novocent Duo, 160 mm) polyurethane catheter by central approach after local infiltration, under ultrasound guidance. A J-tipped guidewire (0.035 mm, 50 cm) was introduced through the needle followed by dilatation of the tract with a dilator (8.5 Fr, 4 inches) and insertion of the catheter on the guidewire. During this procedure, the guidewire was inadvertently pushed further ahead into the vein. This went unnoticed by the resident, who tried to aspirate blood from both the lumen to confirm proper positioning of the catheter. Due to inability to aspirate free flow of blood from one of the lumen, the resident flushed saline through that lumen, which could have resulted in embolization of the guidewire. After completion of the procedure, he realized that the guidewire was missing and informed the seniors. An urgent chest X-ray [Figure 1] and X-ray kidneys, ureters, and bladder [Figure 2] were done in which guidewire was clearly visible. It was removed by gooseneck snare device through femoral percuteneous approach under local anesthesia and fluoroscopic guidance without any complication. Figure 1 Chest X-ray showing guidewire Figure 2 X-ray kidneys, ureters, and bladder showing embolized guidewire For the management of guidewire embolism, if the guidewire has embolized systemically, chest X-ray and if required X-ray abdomen will determine the position of the guidewire. The percutaneous method of extraction has fewer complications for which interventional radiology techniques such as dormia basket, gooseneck snare, endovascular forceps are preferable.[4] Cheddie and Sing[5] describe a similar approach for guidewire extraction using a goose snare device. Our take home massage is that, the complications of CVC should be kept in mind during cannulation. The guidewire should not be inserted too far as average distance from all access site is 18 cm. One should hold the guidewire tip firmly while introducing the catheter and should check the guidewire outside before flushing the percutaneous catheter. Without free flow of blood during aspiration, one should not flush the catheter. Gooseneck snare technique is safe for removal of embolized guidewire.

An Unusual Cause of Ventricular Tachycardia: Port-A-Cath Fracture and Embolization into the Pulmonary Artery

We describe the case of a patient with a previously placed Port-A-Cath who was admitted to hospital for new onset of non-flushing catheter and palpitations with ventricular tachycardia. A chest X-ray and a linogram showed a Port-A-Cath fracture and distal embolization into the right ventricle resulting in ventricular tachycardia. The catheter was removed percutaneously using a Goose Neck snare with no complications and resolution of the ventricular tachycardia. The removed segment demonstrated thrombus. Prompt removal of the embolized catheter fragments should be undertaken given the subtle nature of the embolization and the potential complications.

Letter to the Editor Use of an endoscopic bioptome for extraction of a retained pacemaker lead tip

A 27-year-old male with D-transposition of the great arteries underwent a Mustard palliative procedure in infancy that was complicated by symptomatic bradycardia requiring implantation of an epicardial ventricular pacemaker at 1 year of age. His device was eventually upgraded to an endocardial dual chamber system when the epicardial lead failed to capture 8 years later. During this upgrade, an atrial lead (St Jude Medical, Tendril, 1688TC-52 cm) was placed within the baffle and an endocardial ventricular lead (Guidant, Sweet Tip, 4269-52 cm) in the anatomic left ventricle (Figure 1). His lead thresholds over the years have progressively worsened requiring more frequent generator exchanges. He was subsequently referred for lead revision. Figure 1 Posteroanterior and lateral chest X rays that show an endocardial atrial lead (white arrow) placed within the baffle and an endocardial ventricular lead (black arrow) in the anatomic left ventricle The ventricular lead was completely extracted with an LLD EZ® stylet and a 14 F excimer laser sheath (Spectranetics, Colorado Springs, CO). We then attempted to extract the atrial lead. The atrial lead was subsequently cut and extraction was attempted. Unfortunately, the lead fractured and unfurled, exposing a sharp end of the pacing cable within the vasculature. With the unfurled end difficult to visualize under fluoroscopy, this limited the ability of using existing tools for extraction (Figure 2). We subsequently employed the use of an endoscopic bioptome (Olympus FG-44 NR-1, reusable rat tooth alligator jaw rotatable grasping forcep) to successfully retrieve the distal tip of the lead (Figure 3). Figure 2 Fluoroscopic still image that shows the old broken atrial lead with its unfurled proximal portion (white arrow) and the gooseneck snare (black arrow) Figure 3 Fluoroscopic cine images that show retrieval of the remaining part of the old atrial lead (white arrow) with an endoscopic bioptome catheter (black arrow) The numbers of cardiac device implantations are steadily increasing [1] as well as the number of cases requiring extraction. Complete removal of the system is essential in those patients who have endovascular infection involving the lead with aggressive organisms such as Staphylococcus [2]. Therefore, there is great interest in improving this technique [3–5]. Currently available tools have their own advantages and limitations. As it was noted in our case, the limitation of the gooseneck snare is that it has to loop around the lead for successful retrieval but this was difficult to achieve given the orientation and state of the partially extracted lead (Figure 4). Encountering retained or remaining parts during an extraction case is not uncommon and often requires a more invasive approach to complete the extraction. This can not only result in fatal complications but also increase procedural morbidity. Here, we report of a challenging extraction case in which an endoscopic bioptome catheter was used to successfully retrieve the remaining part of an endocardial lead. As shown in Figure 3, precise localization and retrieval is feasible and relatively easier with the bioptome catheter. Figure 4 Retrieved portion of the old atrial lead that shows its unfurled proximal end (white arrow) Challenging extraction cases in which parts of the leads are retained within the endocardial system, use of bioptome catheter under fluoroscopic guidance can facilitate complete removal of these parts.

Dislodgement of port-A catheters in pediatric oncology patients: 11 years of experience

BackgroundPort-A catheters are frequently used in pediatric cancer patients. Their dislodgement is potentially seriously risky although the incidence is not high. We analyzed our 11 years of data to address this important problem.MethodsFrom January 2001 to December 2011, 330 port-A catheters of different brands were implanted in pediatric cancer patients. In total, eight children suffered a dislodgement of their catheter. Their ages ranged from four to thirteen years, with a median age of ten. Five patients presented with catheter dysfunction, two presented with a cough and one was identified incidentally during surgery to remove his port.ResultsThe downstream ends of the dislodged catheters were located in the right atrium (three patients), left pulmonary artery (three) and inferior vena cava (two). Six of the eight catheters were broken at the site of anastomosis to the port and the other two were broken halfway in between. All episodes of dislodgement happened after the chemotherapy regimen was completed. The dislodged catheters were successfully retrieved without complications by transcatheter retrieval using a gooseneck snare.ConclusionsThe dislodgment rate of port-A catheter in our series was 2.4%. Chest X-rays can rapidly detect the problem. Most of the catheters were broken at the site of anastomosis. Earlier explantation of port-A catheters after completing chemotherapy may be considered to avoid the dislodgement of catheters, but this needs to be weighed against the possibility of underlying disease recurrence. However, we should re-examine how long port-A catheters need to be retained after chemotherapy considering the improved cure rate of pediatric cancer.

Rescue removal of disrupted balloon catheter from right coronary artery and aortic arch

We present the case of a 70-year-old female patient diagnosed with unstable angina, who was qualified to coronarography in a peripheral interventional cardiology department. Critical stenosis of right posterior descending artery was found. During percutaneous coronary intervention, after-stent balloon catheter interrupted and was left partially in the right coronary artery sticking out of the aortic arch. In a second attempt at removal, using an Amplatz GooseNeck snare, operators managed to take the broken balloon out of the intravascular space.