Cateteres intravenosos fraturados: retirada por técnicas endovasculares

Abstract

OBJECTIVE: Central venous access is an increasingly frequent procedure and intravenous catheter fractures and fragments embolization, although being rare, correspond to the most common intravascular foreign bodies. This study purpose is to show our experience in the removal of these foreign bodies employing endovascular techniques. MATERIALS AND METHODS: Retrospective analysis of ten consecutive cases in the last five years, including patients with ages ranging from 9 months to 67 years. RESULTS: The procedure was successfully performed in all the cases by means of different techniques and with no complication. Most common fragments lodgement sites were: right atrium, superior vena cava and left pulmonary artery. The retrieval of these foreign bodies by means of endovascular techniques is a relatively simple procedure when compared to the surgical alternative, and has been safely and successfully performed in countless patients. The available devices have proven quite effective and, among them, the loop snare is the most versatile. CONCLUSION: The high success rate with few complications reported, even in children, allows us to say that, whenever possible, intravascular foreign objects percutaneous extraction should be performed.2 Notwithstanding, familiarization with the several techniques available is essential, allowing combinations and modifications, according to each situation.

Táticas e técnicas endovasculares para retirada de corpos estranhos intravenosos

“…The main catheter-related complications include venous or catheter thrombosis and infection. Embolization of a catheter or a fragment from the catheter is rare and occurs in around 1% of patients [1][2][3][4]. Despite its low incidence, embolization may cause severe and potentially fatal complications such as: thromboembolia [5,6], bacterial endocarditis [7], sepsis, myocardial lesions, and cardiac arrhythmias [8].…”

Embolização para veia cava inferior de cateter totalmente implantável para quimioterapia

“…Catheter fragments can cause complications such as cardiac perforation, arrhythmia, sepsis, and pulmonary embolism, since they behave like a foreign body in the venous system. 6 The mechanism of fracture is by compression of the catheter between the clavicle and the first rib, putting stress on the material, and rupture can be partial or total. Fractures generally occur when the catheter has been placed by puncture.…”

Percutaneous Intraluminal Intravascular Retrieval of Foreign Body Under Ultrasound Guidance

“…Depending on the degree of difficulty of the procedure, one femoral vein can be used, or both simultaneously, although it is always preferable to use only one access. One of the complications associated with such a procedure is transitory cardiac arrhythmias, which are related to the manipulation within cardiac chambers [4].…”