Concurrent use of pigtail and loop snare catheters for percutaneous retrieval of dislodged central venous port catheter

Abstract

The purpose of this study was to report our experience of percutaneous retrieval of dislodged port catheters with concurrent use of pigtail and loop snare catheters. During a 5-year period at our institute (June 2005 to July 2010), a total of 23 dislodged port catheters were retrieved. The interval between port catheter implantation and dislodged catheter retrieval ranged from 43 days to 1,414 days (mean 586.7 days). The time of delayed retrieval ranged from 1 day to 45 days (mean 4.6 days). All dislodged catheters were retrieved with the concurrent use of pigtail and loop snare catheters via femoral venous route. The prevalence of port catheter dislodgement at our institute was 3.4%. All dislodged port catheters were removed successfully with pigtail and loop snare catheters together. No procedure-related complications were encountered, except for transient arrhythmia in two patients, which required no medication. In conclusion, the concurrent use of pigtail and loop snare catheters is a feasible and easy way for percutaneous retrieval of a dislodged central venous port catheter.

Figure 1

Diagrams showing concurrent use of pigtail and loop snare catheters to remove dislodged port catheter. (A) Diagram showing dislodged port catheter in right hepatic vein and right ventricle without accessible free end. (B) The pigtail catheter encompasses the port catheter. (C and D) The pigtail catheter hooks the port catheter and pulls it down to get at least one free end of the port catheter. Then the loop snare catheter is advanced to the target free end. (E and F) Once the loop snare is firmly tightened around the port catheter, the system is removed successfully via the vascular sheath.

Figure 2

Diagrams showing concurrent use of pigtail and loop snare catheters to remove dislodged port catheter. (A) Diagram showing dislodged port catheter in right hepatic vein to right brachiocephalic vein without accessible free end. (B) The pigtail catheter encompasses the port catheter. (C–F) The loop snare catheter grasps the tip of the pigtail catheter and works together as a pulley system to pull down the dislodged port catheter into the vascular sheath.

Figure 3

A 71‐year‐old male with colorectal cancer who had a port catheter inserted for 455 days. (A) The port catheter was inserted medially into the right subclavian vein and led to compression of the catheter between the right first rib and right clavicle (arrow). (B) Six months later, the catheter was fractured and dislodged in the superior vena cava (arrows).

Figure 4

A 47‐year‐old female with breast cancer who had port catheter inserted for 507 days. (A) The dislodged venous port catheter was located from middle hepatic vein to right atrium (arrows). (B–D) The pigtail catheter was advanced to the port catheter and rotated, entwining the port catheter, and was pulled down until an accessible free end of the catheter was obtained. (E) The loop snare catheter was directly advanced to the free end and the port catheter was snared. The port catheter was captured and removed successfully.

Figure 5

A 42‐year‐old male with colorectal cancer who had port catheter inserted for 1,414 days. (A) The pigtail catheter was advanced and hooked to the port catheter. Then, the loop snare catheter was advanced to approach the tip of the pigtail catheter. (B and C) Once the tip of the pigtail catheter was snared by the loop, the pigtail and loop snare catheters worked as a pulley system to pull down the port catheter. At this time, the operator had to provide a steady and gentle force to pull the whole system downward along the inferior vena cava. (D and E) The whole system, including the port, pigtail, and loop snare catheters was removed successfully via the vascular sheath.