Percutaneous silicon catheter insertion into the inferior vena cava, following percutaneous nephrostomy exchange

Iatrogenic vascular complications of non-vascular percutaneous abdominal procedures

PURPOSE

The purpose of this paper is to compile and present all of the reported vascular complications that resulted from common non-vascular abdominal procedures in the literature. Non-vascular procedures include, though are not limited to, percutaneous abscess/fluid collection drainage (PAD), percutaneous nephrostomy (PN), paracentesis, percutaneous transhepatic cholangiography (PTC)/percutaneous biliary drainage (PBD), percutaneous biliary stone removal, and percutaneous radiologic gastrostomy (PG)/percutaneous radiologic gastrojejunostomy (PG-J). By gathering this information, radiologists performing these procedures can be aware of the associated vascular injuries, as well as take steps to minimize risks.

METHODS

A literature review was conducted using the PubMed database to catalog relevant articles, published in the year 2000 onward, in which an iatrogenic vascular complication occurred from the following non-vascular abdominal procedures: PAD, PN, paracentesis, PTC/PBD, percutaneous biliary stone removal, and PG/PG-J. Biopsy and tumor ablation were deferred from this article.

RESULTS

214 studies met criteria for analysis. 28 patients died as a result of vascular complications from the analyzed non-vascular abdominal procedures. Vascular complications from paracentesis were responsible for 19 patient deaths, followed by four deaths from PTC/PBD, three from biliary stone removal, and two from PG.

CONCLUSION

Despite non-vascular percutaneous abdominal procedures being minimally invasive, vascular complications still can arise and be quite serious, even resulting in death. Through the presentation of vascular complications associated with these procedures, interventionalists can improve patient care by understanding the steps that can be taken to minimize these risks and to reduce complication rates.

Successful Management of an Inadvertent Placement of a Nephrostomy Tube Into the Inferior Vena Cava Following Percutaneous Nephrolithotomy: A Case Discussion and Literature Review of a Rare Complication

In a percutaneous nephrolithotomy (PCNL) procedure, the placement of the nephrostomy tube is usually inserted last to monitor and maintain urine drainage, avoid potential urine extravasation, and ensure hemostasis. In this report, we provide a clinical case involving the misplacement of a nephrostomy tube, resulting in direct perforation of the inferior vena cava (IVC) after undergoing one-sided PCNL that was successfully treated conservatively, and investigate the current management censuses from the literature for intravenous misplacement of a nephrostomy tube. In our patient, the tip of the nephrostomy catheter was located in the IVC. It was successfully managed using a one-step catheter withdrawal with the surgical vascular team on standby for any potential encounters with massive uncontrollable bleeding. An enhanced CT angiogram on day 14 post-PCNL revealed a lower polar renal arteriovenous pseudoaneurysm which required our patient to undergo selective angioembolization, resulting in maximal parenchymal preservation. The patient was successfully managed and discharged uneventfully. Thirteen cases that have reported inadvertent misplacements in the PubMed database have been discussed in this review. Our case would be the first documented report where a percutaneous nephrostomy drainage tube pierced through the IVC directly. Our case provides an argument for patients to be managed by tube withdrawal under one-step fluoroscopic guidance. Intensive care measures and ultrasound monitoring for two hours followed by another CT angiogram proved effective successful conservative management in a high-volume urologic practice.

Misplaced drainage tube inserted in the vein in a percutaneous nephrostomy: a case series

Percutaneous nephrostomy is a critical procedure for establishing surgical pathways from the skin to the renal collecting system. The drainage tube involved in the procedure rarely deviates into the renal vein. Herein, we report three cases in which the related drainage tube was mistakenly inserted into the renal vein and inferior vena cava after the renal vein was injured during percutaneous nephrostomy. In the three cases, the nephrostomy tube and double-J tube were gradually withdrawn from the renal pelvis or renal calyces under computed tomography (CT) monitoring. In case 1, the fistula tube was not completely withdrawn in time into the renal, causing multiple thromboses in the vein. The fistula was successfully withdrawn from the vena cava after the filter was placed. Finally, the stones were cleared in two cases and one case was discharged without complications after substantial renal function recovery. A safe and reliable approach is to gradually withdraw, within a short timeframe and under CT monitoring, an ectopic renal vein or inferior vena cava drainage tube into the renal pelvis. Removal of the catheter to the renal pelvis or calyces within 3 days can reduce thrombotic complications.

Management of inferior vena cava injury and secondary thrombosis after percutaneous nephrolithotomy: a case report

Percutaneous nephrolithotomy (PCNL) remains an important method for treating upper urinary calculi. However, bleeding and peripheral vascular injury are serious complications of PCNL. Injury of the inferior vena cava accompanied by secondary thrombosis has rarely been reported clinically. We treated a patient who experienced bleeding during PCNL to establish a channel. A catheter was used to make a renal fistula, and the inferior vena cava was implanted. The wound was fixed and compressed by balloon injection, and secondary thrombosis and repeated infection occurred after the operation. A filter was then placed, the water balloon was released, and the fistula was removed. The anti-bacterial and anticoagulant filter was removed. This major complication was successfully managed. In our patient, during PCNL, the renal fistula entered the inferior vena cava by mistake. If this issue cannot be treated in time, it can easily lead to the formation of secondary thrombosis. A fistula can be extracted through an inferior vena cava filter, and anticoagulant treatment and other conservative treatment regimens can be used to treat patients in this situation. These treatments avoid the possibility of further damage from open surgery.

Visualization of the renal vein filled with contrast agent may indicate the renal vein injury during percutaneous nephrolithotomy: two case reports

Background

Intravenous misplacement of a nephrostomy tube is a rare complication of percutaneous nephrolithotomy (PCNL) or percutaneous nephrostomy. The mechanism of misplacement of a nephrostomy tube into the vascular system is seldom investigated. One type of the possible mechanism is that the puncture needle penetrates a major intrarenal tributary of the renal vein and enters the collecting system. However, the guidewire is located outside the collecting system near the large branches of renal vein or perforates into the renal vein. The dilation is performed and causes a large torn injury. Subsequently, the nephrostomy tube is placed inside the vessel when radiological monitoring is not used. However, there is no imaging evidence and the scene of procedure is not demonstrated. This paper reports two cases of visualization of the renal vein filled with contrast agent during PCNL. The findings may be good evidence to support the step of renal vein injury in patients with intravenous nephrostomy tube misplacement.

Case presentation

We presented two cases with visualization of the renal vein filled with contrast agent during PCNL. In the process of injecting the contrast agent through the puncture needle, we could see the renal vein. Moreover, it was identified that the puncture needle tip was not on the optimal position. The position of puncture needle tip lay outside the collecting system, which was close to the calyceal infundibulum and branches of renal vein.

Conclusions

Visualization of the renal vein filled with contrast agent may be good evidence to verify the renal vein injury in patients with intravenous nephrostomy tube misplacement during PCNL or percutaneous nephrostomy. The suboptimal location of the puncture needle tip and visualization of the renal vein filled with contrast agent indicate the renal vein injury. One type of mechanism of intravenous nephrostomy tube misplacement is as following. Firstly, the guidewire stays outside the collecting system. Subsequently, dilatation directed by the guidewire results in the injury of the vein. Then, the nephrostomy tube migrates into the venous system due to prompt tube inserting and the direction of the sheath and/or the guidewire to the injured vein.

Nephrostomy Tube Misplaced into the Right Atrium: An Extremely Rare Case and Review of the Literature

Although percutaneous nephrolithotomy is generally safe, it has various complications. We present an extremely rare case in which the nephrostomy tube pierced renal parenchyma, proceeded through the right renal vein and inferior vena cava, finally reaching the right atrium. Such a tube misplaced to atrium level was firstly reported, which was safely withdrawn using a 2-step process under fluoroscopic monitoring. We also recommend the tube be marked with different color lines to maintain awareness of the tube length that has passed the peel-away sheath. Such information might help to avoid such complication.

Intravenous misplacement of the nephrostomy catheter following percutaneous nephrostolithotomy: a case report and literature review

Intravenous misplacement of the nephrostomy catheter following percutaneous nephrostolithotomy (PCNL) is extremely rare, and little information is available about this complication. Because the patient’s prognosis may be poor, sufficient attention should be paid to early identification and treatment of this complication. We present an uncommon case of a patient with intravenous nephrostomy catheter misplacement after PCNL at our hospital. In our patient, the tip of the nephrostomy catheter was located in the inferior vena cava. It was successfully managed using two-step catheter withdrawal under fluoroscopy, and the percutaneous nephrostomy catheter was able to be withdrawn 7 to 8 cm back into the collecting system in stages with the surgical team on standby. There were no severe complications such as deep vein thrombosis that developed during or after the catheter withdrawal. Patients could be managed conservatively using intravenous antibiotics, strict bed rest, and tube withdrawal using computed tomography (CT) or fluoroscopy guide in most cases combined with information in the literature. Additionally, open surgery could be used as an alternative treatment.

Nephrostomy catheter entering the right renal vein during an exchange procedure: A case report and literature review

INTRODUCTION

We encountered an extremely rare case of a nephrostomy catheter entering the right renal vein during an exchange procedure.

CASE PRESENTATION

An 80-year-old man underwent radical cystectomy. Urinary diversion was achieved through right percutaneous nephrostomy. After the 15th nephrostomy catheter exchange, the patient bled heavily from the catheter. We clamped the catheter immediately, and the patient became hemodynamically stable. Emergency angiography showed the nephrostomy catheter entering the renal vein from outside the renal pelvis. Under fluoroscopy, we pulled the catheter until its tip was located in the previous penetration site of the renal pelvic wall and inserted the catheter over the guidewire into the renal pelvis.

CONCLUSIONS

Herein, we report an extremely rare case of a nephrostomy catheter inserted into the right renal vein during an exchange procedure. Inserting a nephrostomy catheter in the appropriate position and performing exchange under imaging guidance techniques could help clinicians avoid severe complications.

Inadvertent insertion of nephrostomy tube into the renal vein following percutaneous nephrolithotomy: A case report and literature review

Percutaneous nephrolithotomy (PCNL) is an effective and well accepted procedure for the treatment of large and complex renal calculi. We encountered a patient with a misplaced percutaneous nephrostomy drainage tube (PNDT) into the contralateral renal vein resulting thrombus formation after undergoing right side PCNL. We placed a temporary filter to prevent embolism and started anti-coagulation therapy immediately and finally the PNDT was removed without bleeding.

Subcostal artery bleeding after percutaneous nephrolithotomy: a case report and literature review

Postoperative bleeding is a dangerous complication after percutaneous nephrolithotomy (PCNL). Pseudoaneurysm, arteriovenous fistula, and arterial laceration are the three most common causes of post-PCNL bleeding. Subcostal artery bleeding is a rare cause. We herein present a clinical case involving a 43-year-old man who presented with right renal complex calculi and was managed by PCNL in the prone position using an inferior calyceal puncture approach. Intermittent extreme bleeding occurred 1 day postoperatively, and immediate renal angiography was performed. However, we found no sign of a pseudoaneurysm, arteriovenous fistula, or arterial laceration. Another well-trained and experienced doctor also found no pseudoaneurysm, arteriovenous fistula, or arterial laceration. After adjusting the catheter position, subcostal artery bleeding finally appeared and was successfully controlled by coils. This finding indicates that subcostal artery damage is one cause of post-PCNL bleeding. We suggest that clinicians should carefully and patiently perform angiography and/or embolization to avoid misdiagnosis and mistreatment.

Intravenous misplacement of the nephrostomy catheter following percutaneous nephrostolithotomy: two case reports and literature review

Background

Intravenous misplacement of a nephrostomy tube after percutaneous nephrostolithotomy (PCNL) is very rare in clinical experiences. This report summarizes the characteristics and management of intravenous misplacement.

Case presentation

We present two uncommon cases of intravenous nephrostomy catheter misplacement after PCNL from among 4220 patients who underwent PCNL between January 2009 and December 2015. The tip of the tube was located in the inferior vena cava in one case and in the renal vein in the other. We preferably performed open surgery to treat the two patients, mainly to remove the residual calculi and to prepare for any possible adverse event. All patients were successfully managed and discharged uneventfully.

Conclusion

Intravenous nephrostomy tube misplacement is an uncommon PCNL complication. Furthermore, the study illustrates the importance of prompt diagnosis of renal vein perforation and its prompt management using open surgery, similar to conservative therapies.

The use of endo-vascular balloon tamponade technique for the removal of a misplaced nephrostomy tube in the inferior vena cava: A case report

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Inadvertent placement of nephrostomy tube in the IVC is rare.

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This tube misplacement usually occurs during percutaneous nephrolithotomy.

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A non- operative extrication method is by minimally invasive interventional radiology.

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We used intravenous balloon tamponade to remove the misplaced tube in an elderly co- morbid patient.

Introduction

Inadvertent placement of a nephrostomy tube into the inferior vena cava (IVC) is an extremely rare complication with few reported cases in the literature.

Case presentation

We present a lady with obstructive uropathy in a solitary kidney in whom an attempt by the community radiologist to place a nephrostomy tube was complicated by wrong insertion into the IVC. This report illustrates how a safe non- surgical removal of this tube using an intravenous balloon tamponade technique was successfully applied.

Discussion

Intravenous placement of nephrostomy catheters into the inferior vena cava is extremely rare complication. A few case reports have been published in the literature. The majority of these cases were removed in the operating room under general anesthesia. Using Intravenous balloon tamponade technique for removal has not been previously reported.

Conclusion

Intravenous balloon tamponade technique is effective and is a good minimally invasive alternative to surgical removal of misplaced nephrostomy tube from IVC.