A modified two-step technique for the retrieval of a chemoport catheter fragment with inaccesible ends

Abstract

Background Migration of central venous catheters is a rare but serious complication. The endovascular approach has been widely used for the retrieval of such fragment, with the two-step technique used for removal of catheter fragments with inaccessible ends. In this case report, we describe a modification of this technique that was used after first attempting the two-step technique unsuccessfully. Case presentation A 42-year-old female with breast cancer had a chemoport inserted for chemotherapy. After 6 cycles of chemotherapy the port could not be flushed and a chest radiograph demonstrated a migrated catheter fragment. CT scan demonstrated that one end of the fragment was in the liver in the middle hepatic vein and the other in the right atrial appendage. A modified 2 step technique, using a pigtail catheter, hydrophilic wire and snare was used to remove this fragment. Conclusion In this case report we highlight a new modification of the 2-step technique that can be employed when the conventional 2 step technique does not work.

Successful coronary sinus left ventricular lead extraction 9 years postimplantation using the wire ThRoUgh Snare Twice (wire TRUST) technique

“…Previous reports have shown that the pigtail catheter was effective in removing catheter fragments without accessible ends, leading to the development of the Wire TRUST technique utilizing the pigtail catheter. 8 , 9 A 4‐Fr pigtail catheter (Terumo) must be positioned at the targeted lead using multidirectional fluoroscopic guidance to initiate the Wire TRUST technique. In situations where positioning the catheter is challenging, such as with an enlarged heart, using a steerable introducer might be beneficial.…”

“…The Wire TRUST technique is relatively simple and effective for grasping a lead with inaccessible ends. Previous reports have shown that the pigtail catheter was effective in removing catheter fragments without accessible ends, leading to the development of the Wire TRUST technique utilizing the pigtail catheter 8,9 . A 4‐Fr pigtail catheter (Terumo) must be positioned at the targeted lead using multidirectional fluoroscopic guidance to initiate the Wire TRUST technique.…”

Layered Sheath-Assisted Dissection and Retrieval of Stuck Port Catheters: A Single-Center Experience

“…Surgical approaches, including venotomy and median sternotomy, are no longer recommended for stuck port retrieval due to their invasive nature. Currently, endovascular retrieval is the preferred procedure, including techniques such as using a guidewire to exert direct force on the catheter by applying a combination of ‘pull-out’ and ‘push-in’ forces along a guidewire, pushing the catheter via a dilator during snaring, utilizing a pigtail catheter with a snare, and endoluminal dilatation with a balloon [ 6 - 9 ].…”

“…Additionally, the two-step retrieval procedure and its modified versions all carry the risk of the free end of the dislodged catheter passing into the heart, making it impossible to retrieve the entire catheter [ 8 ]. Furthermore, in techniques that involve squeezing forces, the use of excessive force may lead to further fracture of the dislodged catheter or puncturing of the vessel wall [ 6 ].…”