Case Report
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World J Cardiol. Sep 26, 2013; 5(9): 369-372
Published online Sep 26, 2013. doi: 10.4330/wjc.v5.i9.369
Endovascular technique using a snare and suture for retrieving a migrated peripherally inserted central catheter in the left pulmonary artery
Hiroki Teragawa, Takashi Sueda, Yuichi Fujii, Hiroaki Takemoto, Yasushi Toyota, Shuichi Nomura, Keigo Nakagawa
Hiroki Teragawa, Takashi Sueda, Yuichi Fujii, Hiroaki Takemoto, Yasushi Toyota, Shuichi Nomura, Department of Cardiovascular Medicine, Hiroshima General Hospital of West Japan Railway Company, Hiroshima 732-0057, Japan
Keigo Nakagawa, Department of Internal Medicine, Chuden Hospital, Hiroshima 730-8562, Japan
Author contributions: Teragawa H wrote the manuscript; Fujii Y, Takemoto H, Toyota Y and Nomura S collected data; Sueda T and Nakagawa K evaluated the study data and revised the manuscript.
Correspondence to: Hiroki Teragawa, MD, PhD, Department of Cardiovascular Medicine, Hiroshima General Hospital of West Japan Railway Company, 3-1-36 Futabanosato, Higashi-ku, Hiroshima 732-0057, Japan. hiroteraga71@gmail.com
Telephone: +81-82-262-1171 Fax: +81-82-262-1499
Received: May 3, 2013
Revised: July 25, 2013
Accepted: August 4, 2013
Published online: September 26, 2013
Processing time: 146 Days and 12.8 Hours
Abstract

We report a successful endovascular technique using a snare with a suture for retrieving a migrated broken peripherally inserted central catheter (PICC) in a chemotherapy patient. A 62-year-old male received monthly chemotherapy through a central venous port implanted into his right subclavian area. The patient completed chemotherapy without complications 1 mo ago; however, he experienced pain in the right subclavian area during his last chemotherapy session. Computed tomography on that day showed migration of a broken PICC in his left pulmonary artery, for which the patient was admitted to our hospital. We attempted to retrieve the ectopic PICC through the right jugular vein using a gooseneck snare, but were unsuccessful because the catheter was lodged in the pulmonary artery wall. Therefore, a second attempt was made through the right femoral vein using a snare with triple loops, but we could not grasp the migrated PICC. Finally, a string was tied to the top of the snare, allowing us to curve the snare toward the pulmonary artery by pulling the string. Finally, the catheter body was grasped and retrieved. The endovascular suture technique is occasionally extremely useful and should be considered by interventional cardiologists for retrieving migrated catheters.

Keywords: Port catheter; Catheter migration; Endovascular suture technique

Core tip: Catheter migration has been reported as a delayed complication of peripherally inserted central catheter (PICC). Retrieval by the endovascular technique using a snare is usually attempted in cases of PICC migration, but there have been some difficulties in retrieving the broken catheter. We encountered a patient with an ectopic PICC in the left pulmonary artery; the ectopic PICC could not be retrieved by the usual method using a snare, but was successful retrieved using a snare and suture technique. The endovascular suture technique is a useful method to retrieve a dislocated or broken catheter and should be considered by interventional cardiologists.