Thromboembolism Associated with Pigtail Catheters

Abstract

Three incidents of asymptomatic arterial thromboembolism associated with polyurethane pigtail catheters occurred during 1,417 cases of left ventricular angiocardiography. No similar incident occurred with polyethylene pigtail or (dacron) Eppendorf and Gensini (style) catheters. In vitro comparison of hydraulic characteristics of polyurethane (Cordis) and polyethylene (Cook) pigtail catheters showed higher flow-pressure transmission through the tip of the Cordis polyurethane catheter favoring dislodgment of any existing clot. The problem of thrombogencity of polyethylene compared with polyurethane remains unsettled. Our experience with polyurethane pigtail catheters has resulted in limitation of their use in our laboratory.

Comparison of the performance of pigtail catheters with different number of sideholes

“…Most of the injected material exits out the sideholes, and it is this fact that accounts for most of the advantages of this catheter, namely, lack of recoil, rarity of intramyocardial injection, and decrease in catheter-induced ventricular irritability. However, the design of this catheter does raise the question of the adequacy of flushing of the terminal segment of the catheter between the last pair of sideholes and the end hole, and the risk of thromboembolism may be increased (1). An identically designed catheter but with fewer sideholes would appear to permit more effective flushing of the terminal segment.…”

Cath lab brain attack: What to do?

“…With this change came reports of embolic complications [2], which if resulting in stroke or myocardial infarction could only be treated supportively. Fortunately we learned to reduce these untoward events by meticulous technique and systemic heparinization.…”

Relief of pressure damping during coronary angioplasty: A device for creating side holes in ptca guiding catheters

“…Although this provides an orifice for blood flow into the catheter tip, a number of problems may result. Loss of strength in the catheter wall may allow buckling when the catheter is used to support balloon catheter advancement, and the rough edges left by these methods may provide a nidus for thrombus formation [2]. The holes may allow the guidewire to leave the guiding catheter, and they may be mechanically disruptive to vascular endothelial surfaces.…”

“…Additional holes only allow more contrast extravasation and further weaken the catheter. Also, with more than two side holes there may be stasis of blood flow between the most proximal and the most distal holes, with increased risk of thrombus formation [2]. We have used this device successfully during PTCA procedures in six patients without any complications.…”