Removal of a knotted subclavian semi-floating pacing wire

Removal of knotted intravascular devices. Case report and review of the literature

OBJECTIVE

to review published reports on knotted intravascular devices/catheters.

METHOD

report of two cases and systematic review of the literature.

RESULTS

a total of 113 reported cases of knotted intravascular devices/catheters were located. Pulmonary artery catheters (Swan-Ganz) were responsible for more than two thirds of the total reported intravascular knots. In 62% (70/113) of the cases withdrawal of the knotted catheters was achieved successfully with different interventional radiological techniques, avoiding the need for surgical exploration. In 32% (36/113) of the patients surgical removal was favoured. Capture with one of the interventional techniques and pulling down the knot into an easily accessible vein to be removed through an open venotomy, was the most common surgical procedure. However, in five cases, an open cardiotomy was required. In seven cases the patient's condition was critical and precluded any surgical procedure, so the knotted catheter was left in situ. The mortality of this event was 8% (9/113).

CONCLUSIONS

interventional radiological techniques have largely replaced open surgical removal. Knotted catheters may need to be surgically removed when (a) the knot is large in size with many loops, or (b) intracardiac fixing of the knot is encountered.

Knotted ventriculoatrial catheter. Case report

In this patient a No. 5 French infant feeding tube was advanced through the right basilic vein into the superior vena cava, and became knotted around the end of an atrial catheter placed in the left common facial vein. The atrial catheter stretched sufficiently to allow excision of the knot as it came through the antecubital incision. It then snapped back up into the axillary vein. A shuntgram with 60% Renograffin demonstrated the position of the ventriculoatrial catheter in the axillary vein. Subsequently, the catheter slid back into the atrial position.

Knotting of central venous catheters: nonsurgical correction

A complete knot occurred in a central venous catheter inserted through the subclavian vein. By passing a spring guidewire into the catheter under fluoroscopic control, the knot was easily untied leaving the catheter correctly in place.

Knotting of a flow-directed catheter about a cardiac structure

An instance of knotting of a flow-directed catheter about an intracardiac structure, presumably part of the tricuspid valve apparatus, is described. Because of the patient's severe pulmonary disease, cardiac surgery to remove the catheter was contraindicated. The central portion of the catheter was allowed to remain in situ, without apparent ill effects over a 16 month period.

A technique for unknotting an intracardiac flow-directed balloon catheter

Described is an unusual complication occurring during right-sided cardiac catheterization using a 7F flow-directed balloon catheter. During an attempt to direct the catheter from the main pulmonary artery into the pulmonary wedge position, the tip became entangled in a loop of catheter and knotted. Initially, all attempts to unknot or remove the catheter failed. A movable core guide wire was passed through the major lumen of the catheter, resulting in the immediate unknotting of the catheter, thus allowing its withdrawal.