Percutaneous retrieval of detached infusion port catheter

Clinical History

The patient had an operation for ductal carcinoma of the breast. For chemotherapy, a port catheter system had been inserted into the left subclavian vein.

Imaging Findings

The patient had an operation for ductal carcinoma of the breast. For chemotherapy, a port catheter system had been inserted into the left subclavian vein (Fig. 1a). After chemotherapy was completed, follow-up clinical examinations were normal. The infusion port was detached from the catheter line for some unknown cause, and a chest X-ray film revealed migration of the catheter tip into the inferior vena cava (Fig. 1b).

Percutaneous treatment was chosen for removal of the fragmented catheter and the right femoral vein was punctured and an 8F sheath was introduced. Under fluoroscopic control, an 8F basket catheter was placed into the inferior vena cava (Fig. 2a). The basket catheter was closed around the tip of the port catheter and the catheter was caught (Fig. 2b). It was pulled back into the introducer sheath system. The fragmented catheter was removed by non-surgical percutaneous retrieval (Fig. 3). No major complications were observed during the procedure.

Discussion

Retained foreign bodies are a relatively common clinical problem. Failure to remove intravascular fragments such as those involved in this case can result in morbidity and mortality. In the past, surgical removal was the only method available. Based on major international reports, we believe that percutaneous retrieval should now be considered the treatment of choice for intravascular foreign bodies. Percutaneous techniques for the extraction of intravascular foreign objects are highly effective, with a low rate of complications. Gooseneck snares, grasping forceps, basket retrievers, and loop-snare techniques may be used. Most intravascular foreign bodies can be removed by non-surgical percutaneous retrieval. If percutaneous removal is not successful, surgical extraction by regional venotomy and arteriotomy can be used. Percutaneous removal of intravascular foreign bodies is a safe, highly effective and successful procedure.

Differential Diagnosis List

Final Diagnosis

Percutaneous retrieval of detached infusion port catheter

URL:	https://www.eurorad.org/case/1685
DOI:	10.1594/EURORAD/CASE.1685
ISSN:	1563-4086