title: An Endovascular Approach to the Entrapped Central Venous Catheter After Cardiac Surgery.
abstract: OBJECTIVE
  Entrapment of central venous catheters (CVC) at the superior vena cava (SVC) cardiopulmonary bypass cannulation site by closing purse-string sutures is a rare complication of cardiac surgery. Historically, resternotomy has been required for suture release. An endovascular catheter release approach was developed.
  
  
  METHODS
  Four cases of CVC tethering against the SVC wall and associated resistance to removal, suggestive of entrapment, were encountered. In each case, catheter removal was achieved using a reverse catheter fluoroscopically guided over the suture fixation point between catheter and SVC wall, followed by the placement of a guidewire through the catheter. The guidewire was snared and externalized to create a through-and-through access with the apex of the loop around the suture. A snare placed from the femoral venous access provided concurrent downward traction on the distal CVC during suture release maneuvers.
  
  
  RESULTS
  In the initial attempt, gentle traction freed the CVC, which fractured and was removed in two sections. In the subsequent three cases, traction alone did not release the CVC. Therefore, a cutting balloon was introduced over the guidewire and inflated. Gentle back-and-forth motion of the cutting balloon atherotomes successfully incised the suture in all three attempts. No significant postprocedural complications were encountered. During all cases, a cardiovascular surgeon was present in the interventional suite and prepared for emergent resternotomy, if necessary.
  
  
  CONCLUSIONS
  An endovascular algorithm to the "entrapped CVC" is proposed, which likely reduces risks posed by resternotomy to cardiac surgery patients in the post-operative period.
authors.affiliation: Department of Radiology, Northwestern Memorial Hospital, 676 N St. Clair Street - Suite 800, Chicago, IL, USA. shamit.desai@northwestern.edu.
authors.forename: Shamit S
authors.initials: SS
authors.lastname: Desai
authors.affiliation: Northwestern University Feinberg School of Medicine, 303 E Chicago Ave, Chicago, IL, USA.
authors.forename: Meghana
authors.initials: M
authors.lastname: Konanur
authors.affiliation: Interventional Radiology, Mallinckrodt Institute of Radiology at Washington University, 510 S Kings Highway Blvd, St. Louis, MO, USA.
authors.forename: Gretchen
authors.initials: G
authors.lastname: Foltz
authors.affiliation: Department of Cardiothoracic Surgery, Northwestern Memorial Hospital, 201 E Huron Street - Suite 11-140, Chicago, IL, USA.
authors.forename: S Chris
authors.initials: SC
authors.lastname: Malaisrie
authors.affiliation: Department of Radiology, Interventional Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 251 E Huron Street, Chicago, IL, USA. sresnick@northwestern.edu.
authors.forename: Scott
authors.initials: S
authors.lastname: Resnick
mesh_terms: D000368:Aged; D006348:Cardiac Surgical Procedures / Q000009:adverse effects* / Q000379:methods; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D062905:Central Venous Catheters / Q000009:adverse effects; D020878:Device Removal / Q000379:methods*; D057510:Endovascular Procedures; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D008297:Male; D008875:Middle Aged; D014683:Vena Cava, Superior
keywords: Cardiac surgery; Cardiopulmonary bypass; Central venous catheter; Entrapped catheter; PICC; Superior vena cava; Venous intervention