Longstanding intracardiac catheter embolism. An unusual autopsy finding

Impact of mechanical stress on flexible tubing used for biomedical applications: Characterization of the damages and impact on the patient's health

Flexible tubing is a key part of a lot of medical devices used in hospital, but may be subjected to a lot of various mechanical stresses that can led to the failure or to complications for the patients. The nature and causes of these mechanical stresses were listed for peristaltic pump tubing, infusion set tubing and catheters. Their consequences in term of tubing damages and particular contamination were reported. The impact of the chemical nature of the tubing, of its size and also the impact of various parameters of the clinical acts were reviewed. Last the consequences for the patient's health were discussed.

An Unusual Cause of Stroke: A "Forgotten" Intracardiac Catheter Discovered After 48 Years

A 48-year-old man with recurrent cerebral ischemic events underwent transesophageal echocardiography to investigate cardioembolic sources because transthoracic echocardiography had spotted a dubious filamentous mass on the mitral valve. A venous umbilical catheter, lost during the hospital stay after his birth, was surprisingly identified in his cardiac chambers. (Level of Difficulty: Beginner.).

Endovascular removal of intravascular foreign bodies: A single-center experience and literature review

OBJECTIVE

To describe causes, clinical signs, experience and endovascular techniques for extraction of intravenous foreign bodies (IFB) and literature review.

METHODS

This retrospective study was based on data collected from the medical records of 51 consecutive patients (26 women and 25 men) treated from July 2007 to May 2020 at a single quaternary center in Brazil and case series with data, published in the literature since 2000 on IFB removal, of at least five patients. The average patient age was 43.54 years (range, 2 months to 84 years). The different retrieval method using the following was used in the procedure: gooseneck snare, guidewire, balloon, and custom snares.

RESULTS

The retrieval process rate was 100%. Thirty-one port-a-caths, six guidewires, four double lumens, three permcaths, three Shiley® catheters, one intra cath, two peripherally inserted central catheters, and one stent were extracted. The locations where the IFBs were most frequently trapped were the right atrium (39.2%), the pulmonary artery (17.64%), the superior vena cava (13.72%), and the right ventricle (16.12%). Single venous access was used in 67.07% of the patients. Femoral access, which was the most commonly used approach, was used in 85.71% of the patients. The loop was used in 64.70% of the patients. A fractured catheter was the main IFB in 60.76% of the cases (31 patients). Only one complication related to the extraction of an IFB was noted in a single patient who suffered from atrial fibrillation (1.96%). The 30-day mortality rate was zero.

CONCLUSION

Percutaneous IFB removal should be considered as an alternative for the treatment and retrieval of IFBs because it is a minimally invasive procedure that is relatively simple, safe, and has low complication rates.

A foreign body in the cephalic vein: A case report

RATIONALE

Foreign bodies in the vasculature usually cause numerous problems for clinical physicians. Physician experience with diagnosing and treating non-iatrogenic foreign body migration in the venous system is insufficient.

PATIENT CONCERNS

Here, we reported a 41-year-old male who had a foreign body in his left forearm following a work-related injury.

DIAGNOSES

X-ray films indicated a 3-mm high-density shadow in the superficial soft tissue of the left forearm. During the operation, the foreign body was imaged by a C-arm fluoroscope to provide a more accurate location.

INTERVENTIONS

The foreign body was removed completely following a microsuture of the cephalic vein.

OUTCOMES

The procedure was uneventful, and the patient remained asymptomatic after 6 months of clinical follow-up.

LESSONS

This case indicated that the foreign body in the superficial tissue needed to be accurately diagnosed and located. X-ray and C-arm fluoroscope imaging should be combined with the patient's medical history to ensure sufficient preoperative preparation.

An unusual complication after placement of an inferior vena cava filter via right internal jugular vein access

INTRODUCTION:

Totally implantable venous access devices are used extensively worldwide in cancer patients for administration of venotoxic agents, blood sampling, and nutrition. Their tip is usually positioned at the junction of superior vena cava and right atrium. Inferior vena cava filters are usually used for deep venous thrombosis in cases where anticoagulation is contraindicated; they can be inserted either via internal jugular or femoral access depending on patient conditions and preference.

CASE DESCRIPTION:

We are describing here a case of totally implantable venous access device fracture following a right internal jugular approach for inferior vena cava filter placement as the patient had inferior vena cava thrombus below the renal veins, extending into the right common iliac vein prohibiting femoral approach.

CONCLUSION:

Iatrogenic fracture of totally implantable venous access device is a potential complication of accessing the internal jugular vein for other procedures such as insertion of inferior vena cava filter.

Retrieval of lost coronary guidewires during challenging percutaneous coronary interventions

INTRODUCTION

The presence of symptomatic or asymptomatic intravascular/intracardiac foreign body (FB) is underreported in the literature, but it is more commonly encountered in clinical practice. Nowadays, losing a coronary stent or a guidewire has become a rare event. However, due to the constant increase in the total number of worldwide performed coronary interventions (PCI) and especially due to an increase also in the technical difficulties of these procedures (i.e., new devices+complex techniques), this kind of "lost FB complication" may again become clinically relevant.

CASE REPORTS

We report two cases where, during challenging PCIs, 0.014-in. guidewires broke, remaining firmly anchored in the coronary tree floating with their proximal part in the aorta. These wires could have been successfully retrieved with a dedicated three-dimensional snare device, which is specifically manufactured for facilitating this kind of retrieval interventions.

CONCLUSIONS

Intracoronary lost guidewires, if untreated, may lead to serious cardiovascular complications, suggesting that one should attempt every possible maneuver to retrieve them from the coronary circulation. By describing the peculiarity of the Entrio snare device, we finally suggest that this kind of dedicated three-dimensional snare device is an excellent tool at cardiologists' disposal for retrieving intracardiac and intravascular lost wires.

Intravenous Port Catheter Embolization: Mechanisms, Clinical Features, and Management

Venous catheters are important therapeutic devices for the administration of fluid and chemotherapeutic agents; however, their use may be associated with serious complications, such as catheter rupture and embolism. Most data on port catheter embolization consist of isolated case reports; only a few studies have examined a large number of patients with port catheter embolism. The purpose of this study was to identify the incidence of clinical symptoms in patients with catheter dislocation and to determine the role of catheter fragment localization in combination with the presenting symptoms. We conducted a retrospective analysis of patients admitted to Martin-Luther University Hospital Center from January 1994 to September 2005. In total, 41 patients with centrally dislocated catheter fragments were analyzed. Most catheter fragments were located in the pulmonary artery, superior vena cava, and right atrium. Of the patients in whom the catheter fragments were located in the right atrium, right ventricle, and the pulmonary artery, 7.3% presented cardiac symptoms. Catheter malfunction occurred in 39%. In 53.7%, catheter embolism was found incidentally. The embolized catheter fragments were retrieved by a goose-neck snare under fluoroscopy within 24 hours after the diagnosis without any complications. The mean length of these fragments was 11.6 cm. Catheter embolism may go undiagnosed for a prolonged period and be found incidentally. In these patients, predominantly local symptoms occur; however, severe systemic clinical signs may develop. The risk of serious complications in asymptomatic catheter embolism is unknown. Catheter fragments should be removed to prevent further complications.

Atypical pulmonary embolism of port catheter fragments in oncology patients

GOALS OF WORK

Embolization of venous catheter fragments to the pulmonary vasculature is a very rare form of pulmonary embolism which is only sporadically reported in the literature. The incidence and clinical picture of this complication are unknown.

PATIENT AND METHODS

In this retrospective analysis between 1999 and 2004, in our clinic, 1,014 port catheters were implanted. In this 5-year period, the patients' files were screened for the incidence of pulmonary embolism of catheter fragments and the accompanying complication rate.

MAIN RESULTS

In 11 patients, port catheter dislodgment and embolism into the pulmonary artery occurred. In all the patients' port examination by fluoroscopy, catheter dislocation and embolization were shown. In these 11 patients, no obvious clinical signs indicating dislocation of catheter fragments into the pulmonary circulation were found. None of these patients demonstrated respiratory symptoms. Heart rate, blood pressure, respiration frequency, and even oxygen saturation were normal. In 7 of the 11 patients, malfunction of port catheter was the first indicator of catheter dislocation. In four patients, embolized catheter fragments were an incidental finding. The main cause of catheter embolization was the pinch off syndrome. All embolized catheter fragments were retrieved by a 'goose-neck' snare without complication.

CONCLUSION

These results suggest that the migration of fractured catheter into the pulmonary artery occurs in 1% of the central port catheter implantation. It is often asymptomatic, and malfunction of the catheter may be the first sign of this complication. The pinch off syndrome might be prevented by using the internal jugular vein or by implantation of the port catheter more laterally in the subclavian vein.

Transluminale Bergung intravasaler Fremdk�rper

Patients with central venous lines or implanted Hickman catheters and port systems, suffer catheter embolization in 0.1-2.8% of the cases due to material fatigue or medical malpractice. In a 58-year-old vascular surgery patient, a central venous line catheter fragment was successfully retrieved from the pulmonary artery using a snare catheter via a transfemoral approach. From this case, we discuss the incidence, clinical aspects, diagnosis and interventional therapy of catheter embolization.

Death during percutaneous transluminal coronary angioplasty (PTCA) and the medicolegal aspects

Coronary embolisation is a very rare complication of the clinically widespread method of percutaneous transluminal coronary angioplasty (PTCA). The well-documented case of a 64-year-old male patient is presented comparing angiographic and morphological findings. The occluded left anterior descending artery (LAD) was successfully dilated during PTCA. Simultaneously the circumflex artery showed acute occlusion. The patient fell into cardiac shock and died after attempted resuscitation and agonal installation of extracorporeal circulation. The autopsy revealed severe residual stenosis of the proximal LAD by parietal thrombosis and occlusion of the proximal circumflex artery by an unattached intraluminal thrombus (0.8 x 0.3 x 0.2 cm) which had been dislocated during PTCA. Autopsy thus confirmed the clinical presumption of coronary embolism and, in addition, disclosed a previously unknown perforation of the femoral artery which had occurred during agonal installation of extracorporeal circulation and contributed to death via severe retroperitoneal hemorrhage. The case is discussed under the aspects of clinical quality control by forensic pathological investigations.

Etiology and retrieval of retained central venous catheter fragments within the heart and great vessels of infants and children

BACKGROUND

The use of centrally positioned venous catheters plays an indispensable role in the care of infants and children.

METHODS

Since 1992 the authors have seen nine patients who experienced fragmentation and migration of catheter fragments into the central circulation. The patients ranged in age from 6 days to 15 years.

RESULTS

Sites of migration included pulmonary artery (five patients), superior vena cava (two patients), hepatic vein and innominate vein (one patient). The elapsed time from recognition of retained catheter fragments until retrieval ranged from a few hours to 6 weeks.

CONCLUSION

All retained fragments were successfully removed during cardiac catheterization without complications.