Entrapment of Guide Wire in an Inferior Vena Cava Filter: A Technique for Removal

Entrapment of a central venous catheter (CVC) guide wire in an inferior vena cava (IVC) filter is a rare, but reported complication during CVC placement. With the increasing use of vena cava filters (VCFs), this number will most likely continue to grow. The consequences of this complication can be serious, as continued traction upon the guide wire may result in filter dislodgement and migration, filter fracture, or injury to the IVC. We describe a case in which a J-tipped guide wire introduced through a left subclavian access without fluoroscopic guidance during CVC placement was entrapped at the apex of an IVC filter. We describe a technique that we used successfully in removing the entrapped wire through the left subclavian access site. We also present simple useful recommendations to prevent this complication.     

Predictors of repeat transarterial chemoembolization in the treatment of hepatocellular carcinoma

ObjectivesRepeat transarterial chemoembolization (TACE) is a common intervention performed for hepatocellular carcinoma (HCC). The aim of this study was to identify predictors of the need for repeat TACE.MethodsBetween 2008 and 2012, data on patient and tumour variables were collected for 262 patients treated with a first TACE procedure for HCC. The decision to perform repeat TACE procedures was made at the completion of the first TACE or after follow-up imaging demonstrated the subtotal treatment of HCC tumours.ResultsRepeat TACE was performed in 67 of 262 (25.6%) patients. Necrosis of HCC, measured after the first TACE, was lower in patients who subsequently received repeat TACE (P = 0.042). On multivariable analysis, total tumour diameter of >5 cm [odds ratio (OR) 2.76, 95% confidence interval (CI) 1.45–5.25; P = 0.002] and increasing age (OR 1.04/year, 95% CI 1.00–1.07; P = 0.030) were predictive of the need for repeat TACE. Measures of liver function and TACE approach (selective versus non-selective) were not predictive of repeat TACE. Median survival did not differ significantly between patients who did (median survival: 21.1 months) and did not (median survival: 26.1 months) receive a repeat TACE procedure (P = 0.574).ConclusionsThe requirement for repeat TACE is associated with older age, increased HCC tumour burden and subtotal TACE-induced HCC necrosis. Importantly, repeat TACE was not associated with reduced survival.     

One-Year Analysis of the Prospective Multicenter SENTRY Clinical Trial: Safety and Effectiveness of the Novate Sentry Bioconvertible Inferior Vena Cava Filter

Purpose

To prospectively assess the Sentry bioconvertible inferior vena cava (IVC) filter in patients requiring temporary protection against pulmonary embolism (PE).

Digital intravenous angiography in the diagnosis of renal artery occlusion

Digital intravenous angiography (DIVA) proved to be highly accurate and sensitive in the diagnosis of six cases of renal artery occlusion. The impact of this new modality on the diagnosis and management of such patients is considered.     

Saphenous vein graft-to-left atrium fistula treated with percutaneous transcatheter embolization with coils

Coronary artery fistulae are rare anomalies that are most commonly congenital and rarely acquired. We present a first case of a vein graft to the left atrium fistula that occurred post coronary artery bypass grafting and was treated with percutaneous transcatheter embolization with coiling. The coil was initially lost in the left atrium, but was successfully retrieved and the fistula was closed. We review the pertinent literature on acquired coronary artery fistulae and their management.     

Repositioning of surgically placed peritoneovenous shunt catheter by forming "in situ" loop snare: case report and review of literature

We describe a technique that allows repositioning of malfunctioning peritoneovenous shunt (PVS) catheters. We report a 67-year-old female with refractory ascites, who presented with malfunctioning PVS. The catheter tip was outside the superior vena cava (SVC), possibly in a small mediastinal vein, which makes its tip inaccessible to regular snares and retrieval devices. We used "in situ" loop snare technique to reposition the tip of the catheter into the inferior vena cava (IVC). In situ loop snare technique can be used to reposition malfunctioning PVS catheters caused by a kink or by malposition of its tip. The technique avoids surgical or interventional replacement of these catheters. This technique can be also used for retrieval of foreign body fragments that have no free ends and, therefore, cannot be captured by a snare or other retrieval devices.     

The oblique coronal view in sonography of the retroperitoneum

The abdominal aorta and inferior vena cava can be seen easily from the right flank on a longitudinal coronal-oblique sonogram, using the liver as an acoustic window. With this view, tortuosity of the abdominal aorta can be shown, just as it appears on frontal aortography in 70% of cases, and similar to aortography in 27% of cases. The proximal renal and common iliac arteries can be demonstrated in 73% and 82% of cases, respectively, when aneurysms are absent, and in 45% and 82% of patients when aortic aneurysms are present. Enlarged posterior abdominal lymph nodes may be detected with accuracy, sensitivity, and specificity of 90% when compared to computed tomography (CT). Prominent gonadal vessels and anomalous or duplicated venae cavae can be displayed longitudinally, just as they might appear on venography. The coronal oblique view from the right flank, and occasionally from the left flank, can be a valuable addition to the standard views obtained during abdominal sonography. It is also a valuable supplement to CT in the differentiation of paraaortic vessels from enlarged lymph nodes.     

Does Heparin Coating Improve Patency or Reduce Infection of Tunneled Dialysis Catheters?

Background and objectives: Tunneled dialysis catheters are prone to frequent malfunction and infection. Catheter thrombosis occurs despite prophylactic anticoagulant locks. Catheter thrombi may also serve as a nidus for catheter infection, thereby increasing the risk of bacteremia. Thus, heparin coating of catheters may reduce thrombosis and infection. This study evaluated whether heparin-coated hemodialysis catheters have fewer infections or greater cumulative survival than noncoated catheters.Design, setting, participants, & measurements: We retrospectively queried a prospective access database to analyze the outcomes of 175 tunneled dialysis catheters placed in the internal jugular vein, including 89 heparin-coated catheters and 86 noncoated catheters. The primary outcome was cumulative catheter survival, and the secondary outcome was infection-free catheter survival.Results: The two patient groups were similar in demographics and clinical and catheter features. Catheter-related bacteremia occurred less frequently with heparin-coated catheters than with noncoated catheters (34 versus 60%, P < 0.001). Cumulative catheter survival was similar in heparin-coated and noncoated catheters (hazard ratio, 0.87; 95% confidence interval, 0.55 to 1.36; P = 0.53). On multiple variable survival analysis including catheter type, age, sex, diabetes, coronary artery disease, peripheral vascular disease, cerebrovascular disease, catheter location, and previous catheter, only catheter location predicted cumulative catheter survival (hazard ratio, 2.03; 95% CI, 1.27 to 3.25, with the right internal jugular location being the reference group, P = 0.003). The frequency of thrombolytic instillation was 1.8 per 1000 catheter-days in both groups.Conclusions: Heparin coating decreases the frequency of catheter-related bacteremia but does not reduce the frequency of catheter malfunction.The two major complications of hemodialysis catheters are thrombosis and infection (1). To prevent catheter thrombosis, an anticoagulant (heparin or citrate) is instilled into both catheter lumens at the end of each dialysis session (2). When a catheter clots despite the anticoagulant lock, a thrombolytic agent [tissue plasminogen activator (tPA) or urokinase] is instilled into the catheter lumens. If the thrombolytic agent is unable to restore catheter patency, the catheter is exchanged over a guidewire.Because catheter thrombosis occurs despite instillation of an anticoagulant lock solution, an alternative approach is to coat the surface of the catheter with heparin. Preliminary short-term observations suggest that heparin-coated catheters are less thrombogenic than noncoated catheters (3). However, there are no published clinical studies comparing the long-term patency of heparin-coated and noncoated catheters in hemodialysis patients.Bacteremia is the second major complication of dialysis catheters. It arises from the bacterial biofilm that forms on the inner surface of the catheter after its insertion in the central vein (4). Catheter-related bacteremia is treated with systemic antibiotics in conjunction with catheter removal, guidewire catheter exchange, or instillation of an antibiotic lock into the catheter lumen after each dialysis session (1). The intraluminal thrombus acts as a nidus for the catheter biofilm, and in vitro studies have shown decreased adherence of bacteria to heparin-coated catheters compared with noncoated catheters (5). Moreover, two randomized clinical trials in hospitalized patients with short-term, nontunneled central vein catheters found a lower risk of catheter-related bacteremia in patients with heparin-coated catheters (5,6).The goal of this study was to determine whether heparin-coated dialysis catheters reduce the risk of catheter dysfunction and infection compared with noncoated catheters.     

Loco-regional lysis with thrombosis older than 10 days: experiences and outcome

Successful treatment of deep vein thrombosis by lysis therapy leads to recanalisation of the occluded vessel saving the venous flaps, thus limiting postthrombotic syndrome. Systemic lysis therapy carries an increased risk of fatal complications (1-2%). However, loco-regional lysis therapy with rtPA stands out as a method of recanalisation without increased complications compared to compression and anticoagulation therapy. According to the leading opinion about systemic lysis therapy it should only be performed if thrombotic age does not exceed 10 days. In this study we examined whether loco-regional lysis therapy is successful with older thrombosis, too. We showed that in thromboses older than 10 days lysis success was slightly decreased whereas postthrombotic syndrome doubled (up to 50%). These results point out loco-regional lysis as a method suitable for thromboses with age up to 10 days only.