Transluminal removal of an embolized venous catheter fragment with coronary angioplasty tools

Central venous catheterization has become an important technique for the diagnosis and management of patients requiring intensive medical care. The use of devices to perform this procedure has been accompanied by a corresponding increase in complications. The embolization of foreign bodies to the venous system is not a rare event. This is a report on the transluminal effective and relatively easy removal of a sheath fragment from the right ventricle using standard angioplasty tools.     

Percutaneous removal of an embolized port catheter: Description of a new coaxial recovery technique including a case‐report

The achievement of coaxiality between recovery device and embolized tubular foreign bodies like central venous catheters is a key point to achieve percutaneous removal. To facilitate this target, we designed a coaxial retrieval loop‐snare device using amodified coronary guiding catheter and a coronary 0.014″ guidewire. This new technique has been bench tested and then successfully used to remove a long Port‐A catheter's fragment embolized into the right sided heart. © 2008 Wiley‐Liss, Inc.     

Transcutaneous removal of an intravenous catheter fragment using a spider FX™ Embolic Protection device

Long‐term use of intravenous catheters can lead to catheter fracture and embolization of fragments. Transcutaneous retrieval of these catheter fragments can be challenging because of their fragility. We report an 8‐year‐old boy with Hemophilia disease who underwent removal of intravenous Port catheter after 7 years of use, resulting in embolization of fractured catheter fragments into the distal pulmonary arteries. The snare technique to pull the snared fragment into a sheath was unsuccessful, and it leads to further breakdown due to its fragility. An alternative technique using a combination of a snare kit and a Spider FX? Embolic Protection Device was employed. This technique allowed the fragments to be secured proximally with the basket device and distally with the snare. The unit was then pulled through a sheath and removed from the body. To our knowledge, Spider FX? Device has not been used in this way before. © 2015 Wiley Periodicals, Inc.     

Transfemoral percutaneous removal of a knotted Swan‐Ganz catheter

Intracardiac knotting of balloon‐tipped flow‐directed catheters during a heart catheterization procedure represents a rare but serious complication. In case that such an event occurs, leading to inability to remove the catheter, various different methods have been described to solve the problem, varying from the least invasive to open heart surgery. The formation of large knots requires surgical removal in the vast majority of cases. We describe the successful nonsurgical removal of a Swan‐Ganz catheter, after the formation of a large double knot, during a right heart catheterization performed without fluoroscopic guidance in the intensive care unit. This technique could serve as a last resort in cases that surgical removal seems inevitable due to size‐related inapplicability of other nonsurgical methods. © 2009 Wiley‐Liss, Inc.     

Resolution of severe cardiomyopathy after catheter ablation of an anteroseptal accessory pathway: A case report

In patients with non-sustained tachyarrhythmias, left ventricular (LV) systolic dysfunction is uncommon. The role of catheter ablation (CA) in asymptomatic patients with tachyarrhythmia remains unclear. We report a 20-year-old patient without sustained tachyarrhythmia with a left ventricular ejection fraction of 20% who underwent radiofrequency catheter ablation (RFCA) of anteroseptal accessory pathway. She achieved normalization of left ventricular systolic function noted on echocardiography performed at 4 weeks post-ablation. Our case highlights significant improvement in LV systolic function after catheter ablation of an “asymptomatic” ventricular pre-excitation. Current guidelines do not endorse ablating asymptomatic patients, but careful follow-up with serial echocardiograms might be warranted. Prophylactic ablation of those patients with clear evidence of LV dyssynchrony or wide left bundle branch pattern and persistent pre-excitation is worth further consideration.     

Antibiotic lock therapy for salvage of tunneled central venous catheters with catheter colonization and catheter‐related bloodstream infection

Central venous catheters (CVCs) represent a significant source of infection in patients undergoing hematopoietic stem cell transplantation and can add to the cost of care, morbidity, and mortality. Organisms forming biofilms on the inner surface of catheters require a much higher local antibiotic concentration to clear the pathogen growth. Antibiotic lock therapy (ALT) represents one such strategy to achieve such high intraluminal concentrations of antibiotics and can facilitate catheter salvage. Patients with catheter colonization (CC) or hemodynamically stable catheter‐related bloodstream infection (CRBSI) received ALT per institutional policy. We analyzed the incidence of CC and CRBSI and salvage rate of tunneled CVCs (Hickman) with ALT in patients undergoing hematopoietic stem cell transplant in this retrospective study. Catheter colonization was noted in 9.8% and CRBSI in 10.7% patients. Gram‐negative bacilli (GNB) accounted for 45% and 83% of isolates in CC and CRBSI, respectively. In patients with CRBSI, the rate of catheter salvage with the use of ALT in addition to systemic antibiotics was 86% compared to 55% in patients with systemic antibiotics use only (P = 0.06). There was no CRBSI related mortality, and no increase in resistant strains was noted at subsequent CRBSI. In conclusion, ALT represents an important strategy for catheter salvage, especially for gram‐negative infections, in a carefully selected patient population.     

Successful treatment of central venous catheter induced superior vena cava syndrome with ultrasound accelerated catheter‐directed thrombolysis

Superior vena cava (SVC) syndrome results from obstruction of flow through the vessel either by external compression or thrombosis. External compression by intrathoracic neoplasms is the most common etiology, especially lung cancer and lymphoma. Thrombosis is becoming increasingly common due to the use of indwelling catheters and implantable central venous access devices. Most patients are unresponsive to anticoagulation alone which appears to be effective only in the mildest cases. However, recent advances in catheter‐based interventions have led to the development of a variety of minimally invasive endovascular strategies to remove venous thrombus and accepted as an important first‐line treatment given its high overall success rate and low morbidity as compared with medical and surgical treatments. Ultrasound accelerated catheter‐directed thrombolysis (UACDT) has been developed to rapidly and completely resolve the existing thrombus. This technique integrates high frequency, low intensity ultrasound (US) with standard CDT in order to accelerate clot dissolution, reducing treatment time and the incidence of thrombolysis‐related complications. An US wave enhances drug permeation through thrombus by disaggregating the fibrin matrix, exposing additional plasminogen receptor sites to the thrombolytic agent. The US energy affects thrombus in the entire venous segment, increasing the probability of complete thrombus clearing. We report the case of a 56‐year‐old man who presented with a 5 days history of SVC syndrome symptoms who had been receiving chemotherapy for colon cancer through a right subclavian vein port catheter. The patient successfully treated with UACDT with EkoSonic^® Mach4e Endovascular device with an overnight infusion. © 2013 Wiley Periodicals, Inc.     

Entrapment of an angioplasty balloon catheter: a case report

This report presents a case in which an angioplasty balloon catheter became entrapped within the lumen of a coronary artery after rupture during percutaneous transluminal coronary angioplasty (PTCA). Prior to this report, balloon rupture had been considered a relatively benign occurrence. However, this case demonstrates that balloon rupture may lead to serious complications.     

Balloon catheter ablation to treat paroxysmal atrial fibrillation: What is the level of pulmonary venous isolation?

BACKGROUND: Unlike the initial balloon ablation catheters that were designed to deliver ablation lesions within the pulmonary veins (PVs), the current balloon prototypes are fashioned to deliver lesions at the PV ostia. OBJECTIVE: Using electroanatomical mapping, this study evaluates the actual location of ablation lesions generated by cryo-based, laser-based, or ultrasound-based balloon catheters. METHODS: In a total of 14 patients with paroxysmal atrial fibrillation, PV isolation was performed using either a cryoballoon catheter (8 patients), laser catheter (4 patients) or ultrasound balloon catheter (2 patients). Patients underwent preprocedural computed tomographic/magnetic resonance imaging. An intracardiac ultrasound catheter was used to aid in positioning the balloon catheter at the PV ostium/antrum. In all patients, sinus rhythm bipolar voltage amplitude maps (using either CARTO with computed tomographic/magnetic resonance image integration or NavX mapping) were generated at baseline and after electrical PV isolation as confirmed by use of a circular mapping catheter. RESULTS: Electrical isolation was achieved in 100% of the PVs. Electroanatomical mapping revealed that after ablation with any of the 3 balloon catheters, the extent of isolation included the tubular portions of each PV to the level of the PV ostia. However, the PV antral portions were left largely unablated with all 3 balloon technologies. CONCLUSION: Using the current generation of balloon ablation catheters, electrical isolation occurs at the level of the PV ostia, but the antral regions are largely unablated.     

Simultaneous use of a diagnostic catheter to facilitate stent deployment in aorto-ostial artery stenosis: A case report

Correct positioning of a stent at an ostial lesion can be difficult due to poor visualisation once the guide is backed out of the artery to allow deployment. This case report illustrates a technique whereby the simultaneous use of a diagnostic catheter allows optimal visualisation of stent position, whilst maintaining a stable guide position well away from the stent. Cathet. Cardiovasc. Diagn. 40:210–211, 1997. © 1997 Wiley-Liss, Inc.     

Surgical removal of intra-aortic balloon catheter with fractured nitinol central lumen: a case report.

A 73-year-old woman suffering from septic shock was given circulatory assistance by intra-aortic balloon pumping (IABP). Eleven hours later, pumping stopped abruptly and blood reflux was observed in the intra-aortic balloon catheter (IABC). We removed it and inserted another IABC; 3.5 h later, pumping stopped again and blood reflux was seen. Removal of the IABC was attempted, as the systolic aortic pressure remained above 100 mmHg, but there was resistance during the removal and as a result 7.5cm of the catheter from the tip remained inside the vessel. Fluoroscopy indicated that the metal tube that formed the central lumen in the balloon was fractured, and that its edge had perforated the femoral artery. The balloon was then removed surgically. Fracture of the metal tube and balloon perforation were confirmed in both the damaged IABCs. Postoperative computed tomography and magnetic resonance imaging indicated a highly severe posterior-anterior bend in the patient's aorta. A vessel model similar to the aorta in this case was made and a reproducibility test was conducted; the central lumen fractured within 3 h and under a microscope the profile of the fractured test lumen was similar to the one in the clinical case. These findings suggest that placing a pumping IABC in a bending aorta causes fracture of the central lumen from fatigue failure because the central lumen is under excessive stress.     

Clinical experience with near-infrared ray catheter,a fluorescent ureteral catheter,on laparoscopic surgery for colon diverticulitis: A case report

Rationale:As the world''s population ages, the number of surgical cases of colovesical fistulas secondary to colon diverticulitis is also expected to increase. The key issue while performing laparoscopic surgery for these fistulas is the avoidance of iatrogenic ureteral injury. There are no reports of Near-infrared Ray Catheter being used in surgery for diverticulitis, which is one of the diseases with the highest risk of ureteral injury. We present a case of a male patient with colovesical fistulas secondary to sigmoid colon diverticulitis who underwent laparoscopic surgery with visualization of the ureter using a new surgical technique in laparoscopic surgery.Patient''s concern:An 82-year-old man presented to our urological department with general fatigue and air and fecal matter in the urine.Diagnoses:Cystography showed delineation of the sigmoid colon. Abdominal computed tomography findings revealed multiple sigmoid colon diverticula with thickened walls as well as large stones and a small amount of air in the bladder. He was diagnosed with a urinary tract infection with colovesical fistulas and bladder stones due to sigmoid diverticulitis.Interventions:After the creation of a transverse colostomy, we scheduled a laparoscopic anterior resection and cystolith removal.Outcomes:Severe inflammatory adhesions around the sigmoid colon and a high risk of ureteral injury were expected preoperatively. After induction of anesthesia, we inserted a Near-infrared Ray Catheter, a fluorescent ureteral catheter, which allowed us to easily identify and visualize the ureter in real-time. This allowed bowel dissection without concerns of ureteral injury. The operative time for the gastrointestinal part of the procedure was 150 minutes, and the patient was in a good general condition after the operation and was discharged on postoperative day 7.Lessons:The course of the ureter was easily and quickly identified by the green fluorescence from the ureteral catheter during laparoscopic surgery for fistulas associated with diverticulitis, where severe inflammation and dense fibrosis were present. Our technique is an easy and feasible approach that provides real-time urethral navigation during surgery for colovesical fistulas secondary to colon diverticulitis.     

Sinus node dysfunction after radiofrequency catheter ablation of atrial flutter: A case report

Atrial flutter (AFL) is the second most common atrial tachyarrhythmia after atrial fibrillation. Catheter ablation (CA) for typical AFL is well-established and has a high success rate and adequate safety. However, sick sinus syndrome (SSS) occasionally occurs when long-term, persistent AFL is terminated by ablation. Sinus node function cannot be assessed during AFL, and the preoperative prediction of underlying SSS has not yet been investigated. When this situation occurs, pacemaker implantation is often necessary. Here, we report a case of SSS after persistent AFL CA.     

A case of giant saphenous vein graft aneurysm successfully treated with catheter intervention

The patient was a 67‐year‐old man who had undergone coronary artery bypass graft surgery using a saphenous vein graft (SVG) 22 years before. Computed tomography angiogram revealed a large aneurysm of the SVG (38 × 42 mm in diameter; 80‐mm long) and total occlusion of the left anterior descending artery (LAD). We first performed percutaneous coronary intervention for chronic total occlusion of the native LAD with bi‐directional approach via the SVG. One month later, we performed the trans‐catheter embolization of the SVG and occluded the SVG using multiple coils. This case demonstrates that trans‐catheter embolization after recanalization of native coronary artery is an effective strategy to treat an SVG aneurysm. © 2015 Wiley Periodicals, Inc.