title: Removal of knotted intravascular devices. Case report and review of the literature.
abstract: OBJECTIVE
  to review published reports on knotted intravascular devices/catheters.
  
  
  METHODS
  report of two cases and systematic review of the literature.
  
  
  RESULTS
  a total of 113 reported cases of knotted intravascular devices/catheters were located. Pulmonary artery catheters (Swan-Ganz) were responsible for more than two thirds of the total reported intravascular knots. In 62% (70/113) of the cases withdrawal of the knotted catheters was achieved successfully with different interventional radiological techniques, avoiding the need for surgical exploration. In 32% (36/113) of the patients surgical removal was favoured. Capture with one of the interventional techniques and pulling down the knot into an easily accessible vein to be removed through an open venotomy, was the most common surgical procedure. However, in five cases, an open cardiotomy was required. In seven cases the patient's condition was critical and precluded any surgical procedure, so the knotted catheter was left in situ. The mortality of this event was 8% (9/113).
  
  
  CONCLUSIONS
  interventional radiological techniques have largely replaced open surgical removal. Knotted catheters may need to be surgically removed when (a) the knot is large in size with many loops, or (b) intracardiac fixing of the knot is encountered.
authors.affiliation: Surgical Sector, Athens General Hospital, G GENNIMATAS, Athens, Greece.
authors.forename: I D
authors.initials: ID
authors.lastname: Karanikas
authors.forename: A
authors.initials: A
authors.lastname: Polychronidis
authors.forename: A
authors.initials: A
authors.lastname: Vrachatis
authors.forename: D P
authors.initials: DP
authors.lastname: Arvanitis
authors.forename: C E
authors.initials: CE
authors.lastname: Simopoulos
authors.forename: M K
authors.initials: MK
authors.lastname: Lazarides
mesh_terms: D000368:Aged; D002408:Catheters, Indwelling / Q000009:adverse effects*; D020878:Device Removal; D005260:Female; D005547:Foreign Bodies / Q000000981:diagnostic imaging* / Q000209:etiology / Q000601:surgery*; D006801:Humans; D008297:Male; D015641:Radiography, Interventional