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

Abstract

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.

Pulmonary Artery Catheter Seemingly Entrapped in the Skull

“…A variety of methods for retrieving an entrapped catheter exist, but it is important to take care in minimizing the manipulation of the catheter, as prolonged manipulation can cause injury to the cardiac or vascular lining or provoke cardiac arrhythmia [3]. One common method for retrieval is through the use of interventional radiological techniques involving a variety of snares such as single-loop, triple-loop, or entwined guidewire techniques [8]. If this is unsuccessful, or impractical due to positioning, it may even be necessary for surgical removal of a knotted or stuck catheter [9].…”

Foreign Intravascular Object Embolization and Migration: Bullets, Catheters, Wires, Stents, Filters, and More

“…Percutaneous ICWE removal has now become the preferred technique due to its high rate of success and low rate of complications [54]. Numerous authors have reported successful ICWE retrieval using a variety of endovascular approaches [54][55][56][57][58]. In the majority of such cases, vascular access has been obtained through central veins (e.g., internal jugular, femoral, or subclavian).…”

“…Indwelling objects, including catheters, wires, and stents may embolize to the heart or the pulmonary artery when utilized in the venous system. Inadequate adhesion to the vessel wall, with subsequent stent dislodgment may be one factor for migration [55].…”

“…Within the venous circulation, migrating objects may come to rest at different anatomic levels depending on the location of placement and object size [55,95]. For venous stents, meticulous procedural planning and selection of the correct device size are both critical.…”