Percutaneous unknotting of intravascular catheters and retrieval of catheter fragments

Abstract

During a 5-year period, percutaneous unknotting of knotted catheters or retrieval of intravascular catheter fragments was performed in 21 patients by various interventional radiologic techniques. Eight of nine knotted Swan-Ganz catheters were successfully released, whereas one required the assistance of a surgical cutdown under local anesthesia; 10 of 11 embolized catheter fragments in various locations were retrieved successfully. One failure occurred with complication of peripheral embolization in the lung. Four case reports are presented. The overall success rate was 95%.

Percutaneous fluoroscopic removal of a knotted Swan–Ganz catheter in a patient with a persistent left‐sided superior vena cava

“…10 Several methods have been described for the removal of a knotted SGC. It is preferable to untie the knot before removal.…”

“…However, these properties also make it easier for coiling to occur. 6,10 In a patient with non-variant anatomy, insertion through the right internal jugular vein or the left subclavian vein reduces the risk of coiling. 9 The presence of a persistent left-sided SVC is rare, but it is the most common congenital variation in the thoracic venous system.…”

“…Tightening of the knot makes untying more difficult and makes the need for surgical intervention more likely. 10 Several methods have been described for the removal of a knotted SGC. It is preferable to untie the knot before removal.…”

“…Other similar methods have been described using straight or hooked Teflon catheters or deflecting wires. 10 Using a loop snare enables greater traction to be applied compared with hook-shaped or pigtail catheters. This enables tighter open knots to be undone.…”

“…The tip of the Swan-Ganz catheter is captured by the snare and is pulled back through the knot.Other similar methods have been described using straight or hooked Teflon catheters or deflecting wires 10. Using a loop snare enables greater traction to be appliedcompared with hook-shaped or pigtail catheters.…”