Novel endovascular technique for removal of adherent PICC

Peripherally inserted central catheters (PICCs) are a popular alternative to central venous lines. PICCs can provide reliable long-term access for intravenous fluids, antibiotics and total parenteral nutrition. Multiple factors can contribute to difficult PICC removal including adherent fibrin and thrombus formation around the catheter. We discuss a novel endovascular retrieval technique to remove tightly adherent PICCs.

A 42-year-old male with history of chronic pancreatitis requiring intravenous pain medications, presented with right upper extremity single lumen PICC that could not be removed by standard techniques. The PICC line had been in place for approximately three years and was no longer functioning appropriately. Ultrasonography demonstrated thrombus alongside the length of the PICC.

In order to remove the PICC we utilized a novel endovascular technique. A 0.018" mandril wire was passed through the lumen of the PICC. Next, a puncture alongside the PICC was performed to place a 6 French (Fr) sheath. A snare was then maneuvered through the sheath and used to capture the tip of the mandril wire. The snare, mandril wire and PICC where withdrawn in unison, looping the PICC tip within the basilic vein. The tip of the PICC was positioned near the antecubital fossa. A small incision was performed to capture the tip of the PICC to remove the catheter.

Tightly adherent PICCs can result after prolonged intraluminal dwell times. We describe a novel endovascular technique that can be utilized for safe and successful removal of difficult embedded PICCs.