A Novel Balloon-Assisted Snaring Technique for Retrieval of Dislodged Port Catheter

Case Report

A 59-year-old female presented with a dysfunctional port. She also noticed that the subcutaneous segment of the port catheter on the chest wall was also impalpable. The patient denied any chest pain or palpitations. A chest radiograph ([Fig. 1]) revealed the catheter separated from the chamber and migrated into the heart straddling the atrioventricular (AV) valve; the central tip extended into the right ventricle (RV), while its peripheral end was in the superior vena cava (SVC). On ultrasound examination, the catheter tip was just visible in the low right internal jugular vein (IJV) with thrombus surrounding the tip and extending to the vessel wall. Urgent percutaneous retrieval of the dislodged port catheter was planned. In the angiography suite using ultrasound guidance, right IJV and right common femoral venous (CFV) access were established. Initially capture of the peripheral tip of the catheter in the IJV was contemplated. However, the tip embedded in thrombus made it difficult for simple loop snare technique. Because of its location, other techniques were thought either challenging or to increase the risk of its dislodgement and embolization further into the RV and pulmonary artery (PA). Via the CFV access, a 14mm×40mm Armada angioplasty balloon (Abbot Vascular, Santa Clara, CA) was introduced over a guidewire and advanced into the SVC alongside the port catheter taking care not to dislodge it. The balloon was gently inflated to “tack” the port catheter to the SVC wall and fix it ([Fig. 2A]). Once its position was secured, a 6 to 10mm trilobed snare device (EN Snare, Merit medical Systems) was introduced from the IJV access. The tip of the stabilized catheter was released free of the wall thrombus. It was then captured and extracted from the neck access, while simultaneously deflating the balloon in the SVC ([Fig. 2B]). Following this the port chamber was also removed from the chest wall. The patient made an uneventful recovery.

Fig. 1 Frontal chest radiograph depicts the chest wall port chamber with its catheter detached and dislodged, one end of which is seen in the SVC and the other projected over the proximal right ventricle.

Fig. 2 (A) A balloon is inflated in the SVC to “fix” the position of the loose end of the dislodged catheter, (B) The free end of the “fixed” catheter is captured using a snare from jugular venous access.

Publication History

Article published online:
12 September 2022

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