Endovascular retrieval of ruptured and dislocated vascular catheter

A 61-year-old female patient was admitted to the cardiology department due to dyspnea and atypical chest pain. She had cervical cancer with metastasis to the lungs which was diagnosed 2 years earlier. The patient was undergoing palliative chemotherapy (vinorelbine) administered through a silicone catheter (Celsite – implantable access port system; B Braun Medical, France) localized in the right subclavian vein. On admission, the patient was hemodynamically stable (blood pressure: 120/80 mm Hg, heart rate: 80 bpm, saturation 98%). Laboratory tests revealed anemia (Hb: 10.1 g/dl, Ht: 31.1%) and elevated serum creatinine (1.2 mg/dl, eGFR 47.0 ml/min/1.73 m²). Pulmonary embolism was excluded using echocardiography and D-Dimer measurement. In echocardiography a longitudinal shadow was found in the heart protruding to the inferior vena cava. Therefore an abdominal X-ray was performed (Figure 1 A). Examination confirmed the presence of a ruptured chemotherapy catheter. A 17.5 cm long catheter was located in the inferior vena cava and right atrium. Due to the risk of thrombus-embolic complications the patient was qualified for endovascular removal of the catheter.
After local anesthesia the right femoral vein was punctured. A 7 Fr vascular sheath was introduced and a 7 Fr Judkins right guiding catheter (Medtronic, USA) was located below the lower tip of the catheter. An Andrasnare AS-10 device with atraumatic 10 mm nitinol loop (Andramed GmbH, Germany) was introduced through the guiding catheter. The device loop was positioned at the very end of the catheter, which enabled coaxially pulling out the ruptured catheter through the 7 Fr sheath (Figures 1 B–D). Fluoroscopy time was 9 min 12 s with a radiation dose of 0.2 Gy. A total of 20 ml of contrast media was used. There were no periprocedural complications. The next day, the remaining part of the broken vascular port chamber was removed surgically from subcutaneous tissue in the right subclavian vein region. The patient was discharged home on the fifth day.
Subcutaneous venous catheters are commonly used in patients with cancer. Located in big veins, they are used for fluid infusion, parenteral nutrition, and administration of chemotherapy agents [1–3]. Early complications associated with catheters occur immediately after the implantation. They can be related to clinical conditions of the patient or to surgical factors. These include skin or vascular perforation, hemothorax, incorrect positioning of...


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