Bailout management of pull-line entrapment following Viabahn stent deployment: A case report

Area of Science:

• Interventional Nephrology
• Vascular Surgery
• Endovascular Interventions

Background:

• Central venous occlusion is a common cause of vascular access failure in hemodialysis patients.
• Endovascular treatment is the preferred approach, but intraoperative complications require careful management.
• A 69-year-old male with end-stage diabetic nephropathy experienced left upper limb and facial swelling due to left brachiocephalic vein occlusion.

Purpose of the Study:

• To report a novel technique for managing a rare complication during covered stent implantation for central venous occlusion.
• To describe a method using a standard angiographic catheter to resolve pull-line entrapment during Viabahn stent deployment.

Main Methods:

• Percutaneous transluminal angioplasty with covered stent implantation under digital subtraction angiography guidance.
• Stabilization of the deployed stent using a standard 5F angiographic catheter to facilitate pull-line retrieval.
• Management of a trapped pull line after Viabahn stent deployment in a hemodialysis patient.

Main Results:

• The pull line became trapped after full stent deployment, posing a risk of displacement and vascular injury.
• The complication was successfully resolved by stabilizing the stent with an angiographic catheter, allowing safe pull-line retrieval.
• This technique avoided the need for specialized balloon catheters, utilizing a readily available device.

Conclusions:

• Viabahn stent pull-line entrapment is a rare but manageable complication.
• Stabilization with a standard angiographic catheter provides a simpler and more accessible solution compared to existing bailout techniques.
• This method minimizes risks of stent migration and vascular injury, especially in resource-limited settings, with careful monitoring essential.