An Endovascular Approach to the Entrapped Central Venous Catheter After Cardiac Surgery

Shamit S. Desai, Meghana Konanur, Gretchen Foltz, S Chris Malaisrie, Scott A Resnick*

*Corresponding author for this work

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Purpose: Entrapment of central venous catheters (CVC) at the superior vena cava (SVC) cardiopulmonary bypass cannulation site by closing purse-string sutures is a rare complication of cardiac surgery. Historically, resternotomy has been required for suture release. An endovascular catheter release approach was developed. Materials and Methods: Four cases of CVC tethering against the SVC wall and associated resistance to removal, suggestive of entrapment, were encountered. In each case, catheter removal was achieved using a reverse catheter fluoroscopically guided over the suture fixation point between catheter and SVC wall, followed by the placement of a guidewire through the catheter. The guidewire was snared and externalized to create a through-and-through access with the apex of the loop around the suture. A snare placed from the femoral venous access provided concurrent downward traction on the distal CVC during suture release maneuvers. Results: In the initial attempt, gentle traction freed the CVC, which fractured and was removed in two sections. In the subsequent three cases, traction alone did not release the CVC. Therefore, a cutting balloon was introduced over the guidewire and inflated. Gentle back-and-forth motion of the cutting balloon atherotomes successfully incised the suture in all three attempts. No significant postprocedural complications were encountered. During all cases, a cardiovascular surgeon was present in the interventional suite and prepared for emergent resternotomy, if necessary. Conclusion: An endovascular algorithm to the “entrapped CVC” is proposed, which likely reduces risks posed by resternotomy to cardiac surgery patients in the post-operative period.

Original languageEnglish (US)
Pages (from-to)453-457
Number of pages5
JournalCardiovascular and Interventional Radiology
Volume39
Issue number3
DOIs
StatePublished - Mar 1 2016

Fingerprint

Central Venous Catheters
Sutures
Thoracic Surgery
Catheters
Superior Vena Cava
Traction
Thigh
Cardiopulmonary Bypass
Catheterization

Keywords

  • Cardiac surgery
  • Cardiopulmonary bypass
  • Central venous catheter
  • Entrapped catheter
  • PICC
  • Superior vena cava
  • Venous intervention

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

@article{b991c0c70c724a9fa7b96c7ce74eeb0a,
title = "An Endovascular Approach to the Entrapped Central Venous Catheter After Cardiac Surgery",
abstract = "Purpose: Entrapment of central venous catheters (CVC) at the superior vena cava (SVC) cardiopulmonary bypass cannulation site by closing purse-string sutures is a rare complication of cardiac surgery. Historically, resternotomy has been required for suture release. An endovascular catheter release approach was developed. Materials and Methods: Four cases of CVC tethering against the SVC wall and associated resistance to removal, suggestive of entrapment, were encountered. In each case, catheter removal was achieved using a reverse catheter fluoroscopically guided over the suture fixation point between catheter and SVC wall, followed by the placement of a guidewire through the catheter. The guidewire was snared and externalized to create a through-and-through access with the apex of the loop around the suture. A snare placed from the femoral venous access provided concurrent downward traction on the distal CVC during suture release maneuvers. Results: In the initial attempt, gentle traction freed the CVC, which fractured and was removed in two sections. In the subsequent three cases, traction alone did not release the CVC. Therefore, a cutting balloon was introduced over the guidewire and inflated. Gentle back-and-forth motion of the cutting balloon atherotomes successfully incised the suture in all three attempts. No significant postprocedural complications were encountered. During all cases, a cardiovascular surgeon was present in the interventional suite and prepared for emergent resternotomy, if necessary. Conclusion: An endovascular algorithm to the “entrapped CVC” is proposed, which likely reduces risks posed by resternotomy to cardiac surgery patients in the post-operative period.",
keywords = "Cardiac surgery, Cardiopulmonary bypass, Central venous catheter, Entrapped catheter, PICC, Superior vena cava, Venous intervention",
author = "Desai, {Shamit S.} and Meghana Konanur and Gretchen Foltz and Malaisrie, {S Chris} and Resnick, {Scott A}",
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An Endovascular Approach to the Entrapped Central Venous Catheter After Cardiac Surgery. / Desai, Shamit S.; Konanur, Meghana; Foltz, Gretchen; Malaisrie, S Chris; Resnick, Scott A.

In: Cardiovascular and Interventional Radiology, Vol. 39, No. 3, 01.03.2016, p. 453-457.

Research output: Contribution to journalArticle

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T1 - An Endovascular Approach to the Entrapped Central Venous Catheter After Cardiac Surgery

AU - Desai, Shamit S.

AU - Konanur, Meghana

AU - Foltz, Gretchen

AU - Malaisrie, S Chris

AU - Resnick, Scott A

PY - 2016/3/1

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N2 - Purpose: Entrapment of central venous catheters (CVC) at the superior vena cava (SVC) cardiopulmonary bypass cannulation site by closing purse-string sutures is a rare complication of cardiac surgery. Historically, resternotomy has been required for suture release. An endovascular catheter release approach was developed. Materials and Methods: Four cases of CVC tethering against the SVC wall and associated resistance to removal, suggestive of entrapment, were encountered. In each case, catheter removal was achieved using a reverse catheter fluoroscopically guided over the suture fixation point between catheter and SVC wall, followed by the placement of a guidewire through the catheter. The guidewire was snared and externalized to create a through-and-through access with the apex of the loop around the suture. A snare placed from the femoral venous access provided concurrent downward traction on the distal CVC during suture release maneuvers. Results: In the initial attempt, gentle traction freed the CVC, which fractured and was removed in two sections. In the subsequent three cases, traction alone did not release the CVC. Therefore, a cutting balloon was introduced over the guidewire and inflated. Gentle back-and-forth motion of the cutting balloon atherotomes successfully incised the suture in all three attempts. No significant postprocedural complications were encountered. During all cases, a cardiovascular surgeon was present in the interventional suite and prepared for emergent resternotomy, if necessary. Conclusion: An endovascular algorithm to the “entrapped CVC” is proposed, which likely reduces risks posed by resternotomy to cardiac surgery patients in the post-operative period.

AB - Purpose: Entrapment of central venous catheters (CVC) at the superior vena cava (SVC) cardiopulmonary bypass cannulation site by closing purse-string sutures is a rare complication of cardiac surgery. Historically, resternotomy has been required for suture release. An endovascular catheter release approach was developed. Materials and Methods: Four cases of CVC tethering against the SVC wall and associated resistance to removal, suggestive of entrapment, were encountered. In each case, catheter removal was achieved using a reverse catheter fluoroscopically guided over the suture fixation point between catheter and SVC wall, followed by the placement of a guidewire through the catheter. The guidewire was snared and externalized to create a through-and-through access with the apex of the loop around the suture. A snare placed from the femoral venous access provided concurrent downward traction on the distal CVC during suture release maneuvers. Results: In the initial attempt, gentle traction freed the CVC, which fractured and was removed in two sections. In the subsequent three cases, traction alone did not release the CVC. Therefore, a cutting balloon was introduced over the guidewire and inflated. Gentle back-and-forth motion of the cutting balloon atherotomes successfully incised the suture in all three attempts. No significant postprocedural complications were encountered. During all cases, a cardiovascular surgeon was present in the interventional suite and prepared for emergent resternotomy, if necessary. Conclusion: An endovascular algorithm to the “entrapped CVC” is proposed, which likely reduces risks posed by resternotomy to cardiac surgery patients in the post-operative period.

KW - Cardiac surgery

KW - Cardiopulmonary bypass

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KW - PICC

KW - Superior vena cava

KW - Venous intervention

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