Experience at a Single Institution with Endovascular Treatment of Mechanical Complications Caused by Implanted Central Venous Access Devices in Pediatric and Adult Patients

Experience at a Single Institution with Endovascular Treatment of Mechanical Complications Caused by Implanted Central Venous Access Devices in Pediatric and Adult Patients

Bertrand Bessoud¹, Thierry de Baere¹, Viseth Kuoch¹, Eric Desruennes², Marie-France Cosset², Nathalie Lassau¹ and Alain Roche¹

^¹ Department of Interventional Radiology, Institut Gustave Roussy, 39 rue Camille Desmoulins, 94805 Villejuif, France.
^² Department of Anesthesiology, Institut Gustave Roussy, 94805 Villejuif, France.

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Fig. 1A. —60-year-old man with colorectal cancer. Radiograph obtained 7 months after placement of central venous access device shows fractured catheter has migrated in right pulmonary artery. Because catheter tips (arrows) are located distally, they will probably be difficult to grasp with loop snare. Therefore, 6-French pigtail catheter was advanced into right pulmonary artery.

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Fig. 1B. —60-year-old man with colorectal cancer. Radiograph obtained after pigtail catheter had been rotated shows enfolded catheter being pulled back into pulmonary artery, then right ventricle and inferior vena cava.

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Fig. 1C. —60-year-old man with colorectal cancer. Radiograph shows custom-made loop snare opened in inferior vena cava.

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Fig. 1D. —60-year-old man with colorectal cancer. Radiograph shows snared catheter being pulled into iliac vein.

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Fig. 1E. —60-year-old man with colorectal cancer. Radiograph shows catheter folded in two as it is being pulled through puncture site.

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Fig. 2A. —52-year-old man with lung cancer and chest port introduced via right internal jugular vein. Chest radiograph shows catheter tip (arrow) in right axillary vein.

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Fig. 2B. —52-year-old man with lung cancer and chest port introduced via right internal jugular vein. Radiograph shows hooked catheter being repositioned with pigtail catheter enfolded around it.

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Fig. 3A. —42-year-old man with abdominal leiomyosarcoma who underwent placement of chest port via left internal jugular vein 13 months earlier. Radiograph obtained during injection of contrast medium through catheter shows distal occlusion, stagnation of contrast medium (arrowheads) alongside distal third of catheter inside fibrin sheath, and extravasation (arrow) through lateral split in sheath.

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Fig. 3B. —42-year-old man with abdominal leiomyosarcoma who underwent placement of chest port via left internal jugular vein 13 months earlier. Radiograph shows open nitinol snare (30-mm diameter) being placed around catheter.

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Fig. 3C. —42-year-old man with abdominal leiomyosarcoma who underwent placement of chest port via left internal jugular vein 13 months earlier. Radiograph shows closed snare being gently pulled to strip fibrin sheath.

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Fig. 3D. —42-year-old man with abdominal leiomyosarcoma who underwent placement of chest port via left internal jugular vein 13 months earlier. Radiograph that was obtained after fibrin-sheath stripping shows satisfactory flow of contrast medium (arrow) through distal hole of catheter.

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