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CardioVascular and Interventional Radiology

, Volume 39, Issue 3, pp 453–457 | Cite as

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

  • Shamit S. Desai
  • Meghana Konanur
  • Gretchen Foltz
  • S. Chris Malaisrie
  • Scott ResnickEmail author
Technical Note

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

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

Notes

Compliance with Ethical Standards

Conflict of Interest

The authors have nothing to disclose.

Ethical Approval

For this type of study formal consent is not required.

Informed Consent

Does not apply.

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Copyright information

© Springer Science+Business Media New York and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2015

Authors and Affiliations

  • Shamit S. Desai
    • 1
  • Meghana Konanur
    • 2
  • Gretchen Foltz
    • 3
  • S. Chris Malaisrie
    • 4
  • Scott Resnick
    • 5
    Email author
  1. 1.Department of RadiologyNorthwestern Memorial HospitalChicagoUSA
  2. 2.Northwestern University Feinberg School of MedicineChicagoUSA
  3. 3.Interventional RadiologyMallinckrodt Institute of Radiology at Washington UniversitySt. LouisUSA
  4. 4.Department of Cardiothoracic SurgeryNorthwestern Memorial HospitalChicagoUSA
  5. 5.Department of Radiology, Interventional Radiology, Northwestern Memorial HospitalNorthwestern University Feinberg School of MedicineChicagoUSA

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