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Leite TFDO, Pazinato LV, Bortolini E, Pereira OI, Nomura CH, Filho JMDML. Endovascular removal of intravascular foreign bodies: A single-center experience and literature review. Ann Vasc Surg 2021; 82:362-376. [PMID: 34936892 DOI: 10.1016/j.avsg.2021.12.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 11/18/2021] [Accepted: 12/01/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To describe causes, clinical signs, experience and endovascular techniques for extraction of intravenous foreign bodies (IFB) and literature review. METHODS This retrospective study was based on data collected from the medical records of 51 consecutive patients (26 women and 25 men) treated from July 2007 to May 2020 at a single quaternary center in Brazil and case series with data, published in the literature since 2000 on IFB removal, of at least five patients. The average patient age was 43.54 years (range, 2 months to 84 years). The different retrieval method using the following was used in the procedure: gooseneck snare, guidewire, balloon, and custom snares. RESULTS The retrieval process rate was 100%. Thirty-one port-a-caths, six guidewires, four double lumens, three permcaths, three Shiley® catheters, one intra cath, two peripherally inserted central catheters, and one stent were extracted. The locations where the IFBs were most frequently trapped were the right atrium (39.2%), the pulmonary artery (17.64%), the superior vena cava (13.72%), and the right ventricle (16.12%). Single venous access was used in 67.07% of the patients. Femoral access, which was the most commonly used approach, was used in 85.71% of the patients. The loop was used in 64.70% of the patients. A fractured catheter was the main IFB in 60.76% of the cases (31 patients). Only one complication related to the extraction of an IFB was noted in a single patient who suffered from atrial fibrillation (1.96%). The 30-day mortality rate was zero. CONCLUSION Percutaneous IFB removal should be considered as an alternative for the treatment and retrieval of IFBs because it is a minimally invasive procedure that is relatively simple, safe, and has low complication rates.
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Affiliation(s)
| | - Lucas Vatanabe Pazinato
- Interventional Radiology Unit, Department of Radiology, University of São Paulo Medical School, São Paulo, Brazil
| | - Edgar Bortolini
- Interventional Radiology, Radiology Department, Heart Institute (InCor), University of São Paulo, São Paulo, Brazil
| | - Osvaldo Ignacio Pereira
- Interventional Radiology Unit, Department of Radiology, University of São Paulo Medical School, São Paulo, Brazil
| | - Cesar Higa Nomura
- Interventional Radiology, Radiology Department, Heart Institute (InCor), University of São Paulo, São Paulo, Brazil
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Wu H, Behera TR, Attia D, Yu X, Shen Q. Retrieval of fractured dialysis catheter through phlebotomy of internal jugular vein: a case report. J Int Med Res 2021; 49:300060521998891. [PMID: 33706587 PMCID: PMC8166385 DOI: 10.1177/0300060521998891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
A central venous catheter is the most common access for initiating hemodialysis. Prolonged access through a central venous catheter increases the risk of infection and dysfunction of the catheter with potential development of catheter-induced thrombosis and embolism. However, fracture and dislodgement of the catheter with subsequent embolization is an unexpected complication. Endovascular treatment is a promising method to remove intravascular foreign bodies. We herein report a case of a 58-year-old woman undergoing prolonged hemodialysis who required central venous catheter removal because of mechanical fracture of the tunneled cuffed catheter and its migration in the internal jugular vein. An urgent chest X-ray showed that the two free ends of the fractured tunneled cuffed catheter were located in the right atrium and right internal jugular vein. Phlebotomy of the internal jugular vein was successfully performed to retrieve the fractured tunneled cuffed catheter and the associated thrombi. In this case, phlebotomy for retrieval of the embolized catheter fragment extending into the right atrium was a safe alternative to an endovascular technique of catheter fragment retrieval. Phlebotomy preserved the integrity of the catheter fragment and its associated thrombus and was both cost-effective and safe.
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Affiliation(s)
- Huizhen Wu
- Department of Nephrology, Chun'an First People's Hospital, Hangzhou, Zhejiang, China
| | | | - Doaa Attia
- Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Xiaoling Yu
- Department of Nephrology, Chun'an First People's Hospital, Hangzhou, Zhejiang, China
| | - Quanquan Shen
- Department of Nephrology, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, Zhejiang, China
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Mori K, Somagawa C, Kagaya S, Sakai M, Homma S, Nakajima T. "Pigtail through snare" technique: an easy and fast way to retrieve a catheter fragment with inaccessible ends. CVIR Endovasc 2021; 4:24. [PMID: 33651249 PMCID: PMC7925774 DOI: 10.1186/s42155-021-00218-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 02/24/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A catheter fragment with inaccessible ends can be retrieved using the well-known two-step method: making a free end with a pigtail catheter and seizing it with a snare catheter. Here we propose an easier and faster modification, named the "pigtail through snare" technique. CASE PRESENTATION A 61-year-old female patient underwent removal of a central venous catheter fragment migrating to the right atrium. Both ends located in the right atrial appendage and left hepatic vein were inaccessible. Initially, a snare loop was opened in the inferior vena cava and a pigtail catheter was advanced through the snare loop to hook the catheter fragment. The free end was created by pulling the pigtail catheter, dragged automatically into the snare loop, grasped, and retrieved immediately. CONCLUSIONS By passing the pigtail catheter through the snare loop in advance, the snaring maneuver becomes easy and fast in retrieving the catheter fragment with inaccessible ends.
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Affiliation(s)
- Kensaku Mori
- Department of Radiology, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, 305-8575, Japan.
| | - Chika Somagawa
- Department of Radiology, University of Tsukuba Hospital, 2-1-1 Amakubo, Tsukuba, 305-8576, Japan
| | - Shun Kagaya
- Department of Radiology, University of Tsukuba Hospital, 2-1-1 Amakubo, Tsukuba, 305-8576, Japan
| | - Masafumi Sakai
- Department of Radiology, University of Tsukuba Hospital, 2-1-1 Amakubo, Tsukuba, 305-8576, Japan
| | - Satoshi Homma
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, 305-8575, Japan
| | - Takahito Nakajima
- Department of Radiology, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, 305-8575, Japan
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Experimental study on the chemico-physical interaction between a two-component cyanoacrylate glue and the material of PICCs. J Vasc Access 2018; 19:58-62. [PMID: 29148010 PMCID: PMC6159817 DOI: 10.5301/jva.5000816] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction: The use of cyanoacrylate glue as sealant on the exit site of peripherally inserted central catheters (PICCs) may offer some important clinical advantages. However, concerns exist about the potential interaction between cyanoacrylate and the material of the catheter itself. The aim of this study was to investigate the possibility of damage to the catheter secondary to a long-term contact with a two-component skin glue (N-butyl + octyl cyanoacrylate). Methods: Twelve PICCs of different brands and types were selected (11 made of polyurethane and one made of silicon). PICCs were glued onto artificial skin pads, slightly wetted with Earle solution. The pads were kept in an egg incubator at 34°C and 60% humidity, for up to twelve weeks. Possible signs of degradation were monitored by surface analyses and mechanical tests. Scanning electron microscopy observations, surface roughness measurements, pressure strength and uniaxial tests were performed. Results: Samples were analyzed after 4, 8 and 12 weeks of contact with the glue. No chemical reaction between the glue and the material of the catheters was evident. The mechanical strength of PICCs was consistently within the ranges of ISO standards. An expected increase in the stiffness of the samples covered with glue was observed in uniaxial tests. The silicon catheter was weaker than the polyurethane catheters and was damaged while trying to remove it from the pad for tests. Conclusions: The long-term use of N-butyl + octyl cyanoacrylate glue on polyurethane PICCs is not expected to be associated to any damage to the catheter.
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Pittiruti M, Malerba M, Carriero C, Tazza L, Gui D. Which is the Easiest and Safest Technique for Central venous Access? A Retrospective Survey of more than 5,400 Cases. J Vasc Access 2018; 1:100-7. [PMID: 17638235 DOI: 10.1177/112972980000100306] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
There is an ongoing debate on the technique for central venous catheterization associated with the lowest complication rate and the highest success rate. In an attempt to better define the easiest and safest venous approach, we have reviewed our 7-year experience with 5479 central venous percutaneous punctures (by Seldinger's technique) for the insertion of short-term (n=2109), medium/long-term (n=2627) catheters, as well as double-lumen, large-bore catheters for hemodialysis and/or hemapheresis (n=743). We have analyzed the incidence of the most frequent insertion-related complications by comparing seven different venous approaches: jugular vein, low lateral approach; jugular vein, high lateral approach; jugular vein, low axial approach; subclavian vein, infraclavicular approach; subclavian vein, supraclavicular approach; external jugular vein; femoral vein. The results of our retrospective study suggest that the ‘low lateral’ approach to the internal jugular vein, as described by Jernigan and modified according to our protocol, appears to be the easiest and safest technique for percutaneous insertion of central venous access, being characterized by the lowest incidence of accidental arterial puncture (1.2%) and malposition (0.8%), no pneumothorax, and an extremely low rate of repeated attempts (i.e. more than two punctures before successful cannulation) (3.3%). We advocate the ‘low lateral’ approach to the internal jugular vein as first-choice technique for venipuncture in both adults and children, for both short-term and long-term central venous percutaneous cannulation.
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Affiliation(s)
- M Pittiruti
- Departments of Surgery and Oncology, Catholic University, Rome - Italy
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Central venous access devices in pediatric malignancies: a position paper of Italian Association of Pediatric Hematology and Oncology. J Vasc Access 2014; 16:130-6. [PMID: 25362978 DOI: 10.5301/jva.5000314] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/26/2014] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Treatment of pediatric malignancies is becoming progressively more complex, implying the adoption of multimodal therapies. A reliable, long-lasting venous access represents one of the critical requirements for the success of those treatments. Recent technical innovations-such as minimally invasive procedures for placement, new devices and novel materials-have rapidly spread for clinical use in adult patients, but are still not consistently used in the pediatric population. METHODS The Supportive Therapy Working Group of Italian Association of Hematology and Oncology (AIEOP) reviewed medical literature focusing on new aspects of central venous access devices (VADs) in pediatric patients affected by oncohematological diseases. RESULTS Appropriate recommendations for clinical use in these patients have been discussed and formulated. CONCLUSIONS The importance of the correct choice, management and use of VADs in pediatric oncohematological patients is a necessary prerequisite for an adequate standard of care, also considering the increased chances of cure and the longer life expectancy of those patients with modern therapies.
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Retrieval of iatrogenic intravascular foreign bodies. J Vasc Surg 2013; 57:276-81. [DOI: 10.1016/j.jvs.2012.09.002] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2012] [Revised: 07/25/2012] [Accepted: 09/02/2012] [Indexed: 11/19/2022]
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Galli S, Zollo A, Cavatorta F, Gazzo P. Accidental migration of ASH-split catheter during central venous catheter replacement: retrieval using an interventional radiology approach. J Vasc Access 2012; 2:64-7. [PMID: 17638263 DOI: 10.1177/112972980100200208] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Catheter fracture and embolization of the distal fragment are well-known complications of subclavian central venous long-term cannulation. In hemodialysis it is an exceptional event. We report a case of accidental rupture of a cuffed hemodialysis catheter with distal migration of a fragment during a procedure of catheter exchange via guide-wire. According to most reported cases, intravascular catheter separation usually occurs completely asymptomatically; our report confirms that catheter embolization itself is usually asymptomatic. Less than one third of the literature-reported cases have associated symptoms, such as palpitations or chest discomfort. Once diagnosed, treatment is an interventional radiological approach, which has a very high success rate. The replacement of permanent cuffed hemodialysis catheters via guide-wire is a delicate procedure and if catheter embolization is diagnosed, the patient must be referred to a center with specific experience in the retrieval of intravascular objects.
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Affiliation(s)
- S Galli
- Department of Nephrology and Dialysis, General Hospital, Imperia - Italy
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Percutaneous retrieval of intravascular venous foreign bodies in children. Pediatr Radiol 2012; 42:24-31. [PMID: 22179682 DOI: 10.1007/s00247-011-2150-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2011] [Revised: 04/20/2011] [Accepted: 04/27/2011] [Indexed: 12/21/2022]
Abstract
BACKGROUND The use of vascular lines both venous and arterial in children has significantly increased in the last decade with the potential risk that an intravascular device may become an intravascular foreign body. Percutaneous retrieval by interventional radiology has become an accepted method of foreign body removal. OBJECTIVE The objective of this study is to describe a single center's experience of percutaneous intravascular foreign body removal in pediatric patients. MATERIALS AND METHODS Between January 2000 and December 2008, 18 patients underwent percutaneous intravascular foreign body retrieval as a complication of venous access devices. The mean catheter days were 181.2 catheter days (1 to 1,146 days). A retrospective review was performed and demographic data and clinical information were recorded, including type, duration, location of access device, embolization location and retrieval technique. RESULTS Eighteen of 19 (94.7%) retrievals were performed with single-loop snares and 1/19 (5.3%) was a triple-loop snare. Seventeen of 19 (89.5%) retrievals were successful. One unsuccessful retrieval was successfully removed by surgery, while the other was retained. CONCLUSION Percutaneous intravascular foreign body retrieval by interventional radiologists is a safe and effective method of retrieving embolized fragments from venous access devices in pediatric patients.
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Surov A, Wienke A, Carter JM, Stoevesandt D, Behrmann C, Spielmann RP, Werdan K, Buerke M. Intravascular Embolization of Venous Catheter—Causes, Clinical Signs, and Management: A Systematic Review. JPEN J Parenter Enteral Nutr 2009; 33:677-85. [PMID: 19675301 DOI: 10.1177/0148607109335121] [Citation(s) in RCA: 106] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Alexey Surov
- From the Department of Radiology, Department of Biology, and Department of Cardiology and Intensive Care Medicine, Martin Luther University, Halle, Germany
| | - Andreas Wienke
- From the Department of Radiology, Department of Biology, and Department of Cardiology and Intensive Care Medicine, Martin Luther University, Halle, Germany
| | - Justin M. Carter
- From the Department of Radiology, Department of Biology, and Department of Cardiology and Intensive Care Medicine, Martin Luther University, Halle, Germany
| | - Dietrich Stoevesandt
- From the Department of Radiology, Department of Biology, and Department of Cardiology and Intensive Care Medicine, Martin Luther University, Halle, Germany
| | - Curd Behrmann
- From the Department of Radiology, Department of Biology, and Department of Cardiology and Intensive Care Medicine, Martin Luther University, Halle, Germany
| | - Rolf-Peter Spielmann
- From the Department of Radiology, Department of Biology, and Department of Cardiology and Intensive Care Medicine, Martin Luther University, Halle, Germany
| | - Karl Werdan
- From the Department of Radiology, Department of Biology, and Department of Cardiology and Intensive Care Medicine, Martin Luther University, Halle, Germany
| | - Michael Buerke
- From the Department of Radiology, Department of Biology, and Department of Cardiology and Intensive Care Medicine, Martin Luther University, Halle, Germany
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Amoretti N, Hauger O, Marcy PY, Hovorka I, Lesbats-Jacquot V, Fonquerne ME, Maratos Y, Boileau P. Foreign body extraction from soft tissue by using CT and fluoroscopic guidance: a new technique. Eur Radiol 2009; 20:190-2. [DOI: 10.1007/s00330-009-1499-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2008] [Revised: 05/10/2009] [Accepted: 05/22/2009] [Indexed: 11/24/2022]
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