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Successful percutaneous retrieval of accidentally migrated hemodialysis catheter
j o u r n a l o f i n d i a n c o l l e g e o f c a r d i o l o g y 2 ( 2 0 1 2 ) 1 2 6 e1 2 8
Available online at www.sciencedirect.com
journal homepage: www.elsevier.com/locate/jicc
Case report
Successful percutaneous retrieval of accidentally migrated hemodialysis catheter Chidambaram Sundar*, Ganesan Gnanavelu, Sangareddi Venkatesan, V.E. Dhandapani, M.S. Ravi, G. Karthikeyan, K. Meenakshi, D. Muthukumar, N. Swaminathan Department of Cardiology, Madras Medical College, Chennai 600003, Tamilnadu, India
article info
abstract
Article history:
Hemodialysis is done for end stage renal failure. It is often done through femoral or jugular
Received 10 June 2012
venous access until a permanent venous access is constructed.1 Although infection and
Accepted 27 June 2012
thrombosis of the access site are quite common, accidental migration of catheter is rare.
Available online 9 July 2012
Here we report a case of accidentally migrated hemodialysis catheter and the subsequent successful retrieval. It has avoided a major surgical intervention and the associated
Keywords:
morbidity.
Percutaneous retrieval
Copyright ª 2012, Indian College of Cardiology. All rights reserved.
Migrated catheter Snare technique
1.
Case report
A 41-year old male with end stage renal failure underwent hemodialysis in a hospital in Saudi Arabia. The hemodialysis catheter accidentally migrated during the exchange process as per the history. He was advised treatment for removal of the catheter. But he refused and came to India. He got admitted in the cardio thoracic surgical department of our hospital for surgical removal of the catheter. Subsequently, after reviewing the fluoroscopic images the patient was transferred to our department for a possible percutaneous
retrieval. Since he was asymptomatic an elective procedure was planned. His blood investigations showed hemoglobin: 8.2 g/dl. Blood sugar: 134 mg/dl, blood Urea: 88 mg/dl, Serum creatinine: 4.6 mg/dl. Sodium: 143 meq/dl, Potassium: 5.1 meq/dl, Calcium 8.4 meq/dl. ECG showed sinus rhythm with left ventricular hypertrophy. Echocardiogram showed concentric left ventricular hypertrophy. Sonography revealed catheter in the inferior venacava.2 Non-surgical retrieval of migrated catheter was performed with a 6 F snare catheter through a 14 F sheath.3 The upper floating end of the catheter was snared and pulled down
* Corresponding author. Tel.: þ91 9444185058. E-mail addresses: [email protected] (C. Sundar), [email protected] (G. Gnanavelu), drvenkatesans@yahoo. com (S. Venkatesan), [email protected] (V.E. Dhandapani), [email protected] (M.S. Ravi), [email protected] (G. Karthikeyan), [email protected] (K. Meenakshi), [email protected] (D. Muthukumar), [email protected] (N. Swaminathan). 1561-8811/$ e see front matter Copyright ª 2012, Indian College of Cardiology. All rights reserved. http://dx.doi.org/10.1016/j.jicc.2012.06.002
j o u r n a l o f i n d i a n c o l l e g e o f c a r d i o l o g y 2 ( 2 0 1 2 ) 1 2 6 e1 2 8
127
Fig. 1 e The migrated catheter in the inferior venacava.
toward the right femoral vein under fluoroscopic guidance.4 (Figs. 1 and 2). Finally the catheter and retrieval sets were removed through the right femoral vein2,5 (Figs. 3a,b and 4). The total procedure time was 10 min, with a fluoroscopic time of 5 min. No major complications occurred and the patient was discharged the following day. With the interventional procedures expanding at a rapid pace it is not uncommon to see such intravascular hardware
Fig. 3 e a, b: The various stages during the removal of catheter through the femoral vein.
Fig. 2 e The catheter held by snare technique.
breakage and migration. Every cath lab must develop the required expertise. The minimum hardwares required for such procedures should be readily available. The success rate of such retrieval directly depends upon the expertise and available hardware. We have successfully removed a temporary pacing guide wire from the superior venacava in the past, while we had a failed-attempt to remove broken piece of amplatz catheter from the root of aorta. We propose non-surgical retrieval of migrated catheter by snare technique should be attempted in every such case before embarking upon surgery.6 We have found
128
j o u r n a l o f i n d i a n c o l l e g e o f c a r d i o l o g y 2 ( 2 0 1 2 ) 1 2 6 e1 2 8
Presentation at a meeting Nil.
Conflicts of interest All authors have none to declare.
references
Fig. 4 e The femoral area after successful retrieval of the migrated catheter.
percutaneous retrieval has proven to be a simple and dramatically rewarding experience.
Sources of support Nil.
1. National Kidney Foundation. III NKF-K/DOQI clinical practice guidelines for vascular access: update 2000. Am J Kidney Dis. 2001;37(suppl 1):S137eS181. 2. Thomas J, Sinclair-Smith B, Bloomfield D, Davachi A. Nonsurgical retrieval of a broken segment of steel spring guide from right atrium and inferior vena cava. Circulation. 1964;30:106e108. 3. Fisher RG, Ferreyro R. Evaluation of current techniques for nonsurgical removal of intravascular iatrogenic foreign bodies. Am J Roentgenol. 1978;130:541e548. 4. Eggebrecht H, Haude M, von Birgelen C, et al. Nonsurgical retrieval of embolized coronary stents. Catheter Cardiovasc Interv. 2000;51:432e440. 5. Yang FS, Ohta I, Chiang HJ, Lin JC, Shih SL, Ma YC. Non-surgical retrieval of intravascular foreign body: experience of 12 cases. Eur J Radiol. 1994;18:1e5. 6. Dondelinger RF, Lepoutre B, Kurdziel JC. Percutaneous vascular foreign body retrieval: experience of an 11-year period. Eur J Radiol. 1991;12:4e10.
Available online at www.sciencedirect.com
journal homepage: www.elsevier.com/locate/jicc
Case report
Successful percutaneous retrieval of accidentally migrated hemodialysis catheter Chidambaram Sundar*, Ganesan Gnanavelu, Sangareddi Venkatesan, V.E. Dhandapani, M.S. Ravi, G. Karthikeyan, K. Meenakshi, D. Muthukumar, N. Swaminathan Department of Cardiology, Madras Medical College, Chennai 600003, Tamilnadu, India
article info
abstract
Article history:
Hemodialysis is done for end stage renal failure. It is often done through femoral or jugular
Received 10 June 2012
venous access until a permanent venous access is constructed.1 Although infection and
Accepted 27 June 2012
thrombosis of the access site are quite common, accidental migration of catheter is rare.
Available online 9 July 2012
Here we report a case of accidentally migrated hemodialysis catheter and the subsequent successful retrieval. It has avoided a major surgical intervention and the associated
Keywords:
morbidity.
Percutaneous retrieval
Copyright ª 2012, Indian College of Cardiology. All rights reserved.
Migrated catheter Snare technique
1.
Case report
A 41-year old male with end stage renal failure underwent hemodialysis in a hospital in Saudi Arabia. The hemodialysis catheter accidentally migrated during the exchange process as per the history. He was advised treatment for removal of the catheter. But he refused and came to India. He got admitted in the cardio thoracic surgical department of our hospital for surgical removal of the catheter. Subsequently, after reviewing the fluoroscopic images the patient was transferred to our department for a possible percutaneous
retrieval. Since he was asymptomatic an elective procedure was planned. His blood investigations showed hemoglobin: 8.2 g/dl. Blood sugar: 134 mg/dl, blood Urea: 88 mg/dl, Serum creatinine: 4.6 mg/dl. Sodium: 143 meq/dl, Potassium: 5.1 meq/dl, Calcium 8.4 meq/dl. ECG showed sinus rhythm with left ventricular hypertrophy. Echocardiogram showed concentric left ventricular hypertrophy. Sonography revealed catheter in the inferior venacava.2 Non-surgical retrieval of migrated catheter was performed with a 6 F snare catheter through a 14 F sheath.3 The upper floating end of the catheter was snared and pulled down
* Corresponding author. Tel.: þ91 9444185058. E-mail addresses: [email protected] (C. Sundar), [email protected] (G. Gnanavelu), drvenkatesans@yahoo. com (S. Venkatesan), [email protected] (V.E. Dhandapani), [email protected] (M.S. Ravi), [email protected] (G. Karthikeyan), [email protected] (K. Meenakshi), [email protected] (D. Muthukumar), [email protected] (N. Swaminathan). 1561-8811/$ e see front matter Copyright ª 2012, Indian College of Cardiology. All rights reserved. http://dx.doi.org/10.1016/j.jicc.2012.06.002
j o u r n a l o f i n d i a n c o l l e g e o f c a r d i o l o g y 2 ( 2 0 1 2 ) 1 2 6 e1 2 8
127
Fig. 1 e The migrated catheter in the inferior venacava.
toward the right femoral vein under fluoroscopic guidance.4 (Figs. 1 and 2). Finally the catheter and retrieval sets were removed through the right femoral vein2,5 (Figs. 3a,b and 4). The total procedure time was 10 min, with a fluoroscopic time of 5 min. No major complications occurred and the patient was discharged the following day. With the interventional procedures expanding at a rapid pace it is not uncommon to see such intravascular hardware
Fig. 3 e a, b: The various stages during the removal of catheter through the femoral vein.
Fig. 2 e The catheter held by snare technique.
breakage and migration. Every cath lab must develop the required expertise. The minimum hardwares required for such procedures should be readily available. The success rate of such retrieval directly depends upon the expertise and available hardware. We have successfully removed a temporary pacing guide wire from the superior venacava in the past, while we had a failed-attempt to remove broken piece of amplatz catheter from the root of aorta. We propose non-surgical retrieval of migrated catheter by snare technique should be attempted in every such case before embarking upon surgery.6 We have found
128
j o u r n a l o f i n d i a n c o l l e g e o f c a r d i o l o g y 2 ( 2 0 1 2 ) 1 2 6 e1 2 8
Presentation at a meeting Nil.
Conflicts of interest All authors have none to declare.
references
Fig. 4 e The femoral area after successful retrieval of the migrated catheter.
percutaneous retrieval has proven to be a simple and dramatically rewarding experience.
Sources of support Nil.
1. National Kidney Foundation. III NKF-K/DOQI clinical practice guidelines for vascular access: update 2000. Am J Kidney Dis. 2001;37(suppl 1):S137eS181. 2. Thomas J, Sinclair-Smith B, Bloomfield D, Davachi A. Nonsurgical retrieval of a broken segment of steel spring guide from right atrium and inferior vena cava. Circulation. 1964;30:106e108. 3. Fisher RG, Ferreyro R. Evaluation of current techniques for nonsurgical removal of intravascular iatrogenic foreign bodies. Am J Roentgenol. 1978;130:541e548. 4. Eggebrecht H, Haude M, von Birgelen C, et al. Nonsurgical retrieval of embolized coronary stents. Catheter Cardiovasc Interv. 2000;51:432e440. 5. Yang FS, Ohta I, Chiang HJ, Lin JC, Shih SL, Ma YC. Non-surgical retrieval of intravascular foreign body: experience of 12 cases. Eur J Radiol. 1994;18:1e5. 6. Dondelinger RF, Lepoutre B, Kurdziel JC. Percutaneous vascular foreign body retrieval: experience of an 11-year period. Eur J Radiol. 1991;12:4e10.