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Transvascular removal of catheter fragments from the great vessels and heart
Insights
Fragment embolization from cardiac catheterization or central venous pressure (CVP) lines can be fatal. Helical baskets effectively retrieve these dangerous fragments, improving patient outcomes.
Area of Science:
- Cardiology
- Interventional Radiology
- Vascular Surgery
Background:
- Catheter fragments or fractured guidewires from cardiac catheterization or central venous pressure (CVP) lines pose a significant risk.
- These fragments can lead to severe illness or death in approximately 50% of affected patients, particularly those who are critically ill.
Observation:
- This report details the successful removal of nine catheter fragments.
- Eight of these removals utilized a helical basket through a Dotter retrieval catheter.
- Different catheter materials (polyethylene vs. silicone) present unique retrieval challenges due to brittleness or pliability.
Findings:
- Helical baskets are effective for retrieving catheter fragments, especially from polyethylene catheters.
- Adapted smaller, pliable helical baskets (Bean-Smith-Mahorner) are useful for navigating tight vessel curves or small diameters.
- A softer, longer right heart catheter may be preferable for right pulmonary artery fragment removal.
Implications:
- Availability of Dotter retrieval catheter sets with various helical baskets is crucial for cardiac catheterization laboratories.
- Prompt retrieval of catheter fragments can prevent serious complications and improve patient survival rates.
- Technological adaptations of retrieval baskets enhance their efficacy in complex vascular anatomies.
Abstract:
Embolization of catheter fragments or fractured spring guidewires used during cardiac catheterization or fractured central venous pressure (CVP) lines is not uncommon. Although CVP lines are usually used in seriously ill patients, often with complications secondary to prior surgical intervention, if the catheter fragments are not removed they can give rise to serious illness or death in about 50% of patients. Experience with the removal of nine such catheter fragments is reported. In eight patients a helical basket was available for removal through a Dotter retrieval catheter. With prolonged hyperalimentation therapy polyethylene catherters become very brittle. They are relatively easy to grip with the wire basket. Silicone elastomer catheters remain pliable but are so bouncy that they are difficult to grip. For removal of catheter fragments from vessels of small diameter, such as the subclavian vein, or vessels in which the catheter has to take an acute bend to enter, such as the right or left pulmonary artery, a smaller, more pliable Bean-Smith-Mahorner biliary stone helical basket was adapted by extending the length of wire to 100 cm. For removal of catheter fragments from the right pulmonary artery it is probably better to use a softer, 100-cm-long no. 8 French right heart catheter. A Dotter retriever catheter set with both large and small helical wire baskets should be available in any cardiac catheterization laboratory.