Ipsilateral pull-through technique using a handmade loop snare catheter for difficult port catheter removal

Area of Science:

• Vascular Surgery
• Interventional Radiology
• Medical Device Technology

Background:

• Totally implantable venous access devices (TIVADs) are essential for long-term therapies.
• Catheter adherence to vessel walls can complicate TIVAD removal, especially after prolonged implantation.
• Standard removal methods may be insufficient for adhered TIVAD catheters.

Purpose of the Study:

• To present a modified endovascular technique for difficult TIVAD removal.
• To evaluate the clinical relevance of this technique in cases of adhered catheters.
• To demonstrate a solution for challenging TIVAD removal scenarios.

Main Methods:

• A retrospective analysis of 367 TIVAD removal procedures between December 2015 and April 2025.
• Comparison of standard removal techniques with a modified ipsilateral pull-through technique.
• Detailed description of the handmade loop-snare construction for the ipsilateral pull-through technique.

Main Results:

• The ipsilateral pull-through technique successfully removed adhered TIVADs in 7 out of 8 patients.
• A median indwelling duration of 2473 days was observed in the cohort requiring this technique.
• One instance of catheter fracture was noted, with no other complications reported; vessel patency was confirmed post-procedure.

Conclusions:

• The modified ipsilateral pull-through technique is a valuable method for detaching adhered catheters during difficult TIVAD removal.
• This technique offers a viable solution for complex cases where standard removal fails.
• The study highlights the safety and efficacy of this approach in managing challenging TIVAD removals.