Novel endovascular technique for removal of adherent PICC.
BACKGROUND
Peripherally inserted central catheters (PICCs) are a popular alternative to central venous lines. PICCs can provide reliable long-term access for intravenous fluids, antibiotics and total parenteral nutrition. Multiple factors can contribute to difficult PICC removal including adherent fibrin and thrombus formation around the catheter. We discuss a novel endovascular retrieval technique to remove tightly adherent PICCs.


METHODS
A 42-year-old male with history of chronic pancreatitis requiring intravenous pain medications, presented with right upper extremity single lumen PICC that could not be removed by standard techniques. The PICC line had been in place for approximately three years and was no longer functioning appropriately. Ultrasonography demonstrated thrombus alongside the length of the PICC.


RESULTS
In order to remove the PICC we utilized a novel endovascular technique. A 0.018" mandril wire was passed through the lumen of the PICC. Next, a puncture alongside the PICC was performed to place a 6 French (Fr) sheath. A snare was then maneuvered through the sheath and used to capture the tip of the mandril wire. The snare, mandril wire and PICC where withdrawn in unison, looping the PICC tip within the basilic vein. The tip of the PICC was positioned near the antecubital fossa. A small incision was performed to capture the tip of the PICC to remove the catheter.


CONCLUSIONS
Tightly adherent PICCs can result after prolonged intraluminal dwell times. We describe a novel endovascular technique that can be utilized for safe and successful removal of difficult embedded PICCs.
Oakland University William Beaumont School of Medicine, Rochester, Michigan - USA.
Julie
J
Le
Division of Vascular and Endovascular Surgery, University of California Irvine, Irvine, California - USA.
Areg
A
Grigorian
Division of Vascular and Endovascular Surgery, University of California Irvine, Irvine, California - USA.
Samuel
S
Chen
Division of Vascular and Endovascular Surgery, University of California Irvine, Irvine, California - USA.
Isabella J
IJ
Kuo
Division of Vascular and Endovascular Surgery, University of California Irvine, Irvine, California - USA.
Roy M
RM
Fujitani
Division of Vascular and Endovascular Surgery, University of California Irvine, Irvine, California - USA.
Nii-Kabu
NK
Kabutey
D000328:Adult; D002405:Catheterization, Central Venous / Q000009:adverse effects* / Q000295:instrumentation*; D002406:Catheterization, Peripheral / Q000009:adverse effects* / Q000295:instrumentation*; D002408:Catheters, Indwelling; D062905:Central Venous Catheters; D020878:Device Removal / Q000379:methods*; D057510:Endovascular Procedures; D006801:Humans; D008297:Male; D010690:Phlebography; D016896:Treatment Outcome