Long loop technique with bifemoral access as salvage technique for repositioning of dislodged port catheters

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Abstract

Abstract Background Repositioning of dislocated port systems’ catheters is usually performed with a pigtail catheter and/or a goose snare. In case of an inaccessible port catheter tip due to thrombosis, this classic approach may be not successful. For these cases, we describe a long loop bailout technique with bifemoral access. Technique Via a right transfemoral access, a first attempt to reposition the dislodged port catheter using pigtail catheter and goose snare was performed. After an unsuccessful attempt and delineation of thrombosis of the catheter tip, the contralateral femoral vein was subsequently punctured and a sheath was placed. Through both vascular sheaths, pigtail catheter and goose wire were advanced distally to the catheter. The guidewire in the pigtail catheter was snared, thus creating a “Long loop” configuration. Pulling down both catheters simultaneously with improved stability allowed to detach the catheter tip from the vessel wall and replacement into the superior vena cava was possible. Refinement of catheter tip position was done using the goose snare . This technique was applied on 5 patients with dislodged port catheters in the jugular vein (2/5), the innominate vein (1/5), the subclavian vein (1/5) and the azygos vein (1/5) with a technical success of 100%. No complications were observed. Conclusion The Long loop technique can be used as salvage approach to reposition a dislodged catheter in case of failure with pigtail catheter and goose snare.

Authors 7

1. Vincent Van den Bosch corresponding Aachen

   Universitätsklinikum Aachen · RWTH Aachen University

   Affiliation as printed

   Uniklinik RWTH Aachen: Universitatsklinikum Aachen

2. Frederic De Beukelaer Aachen

   Universitätsklinikum Aachen · RWTH Aachen University

   Affiliation as printed

   Uniklinik RWTH Aachen: Universitatsklinikum Aachen

3. Peter Isfort Aachen

   Universitätsklinikum Aachen · RWTH Aachen University

   Affiliation as printed

   Uniklinik RWTH Aachen: Universitatsklinikum Aachen

4. Sebastian Keil Aachen

   Universitätsklinikum Aachen · RWTH Aachen University

   Affiliation as printed

   Uniklinik RWTH Aachen: Universitatsklinikum Aachen

5. Christiane Katharina Kuhl Aachen

   Universitätsklinikum Aachen · RWTH Aachen University

   Affiliation as printed

   Uniklinik RWTH Aachen: Universitatsklinikum Aachen

6. Philipp Bruners Aachen

   Universitätsklinikum Aachen · RWTH Aachen University

   Affiliation as printed

   Uniklinik RWTH Aachen: Universitatsklinikum Aachen

7. Federico Pedersoli Aachen

   Universitätsklinikum Aachen · RWTH Aachen University

   Affiliation as printed

   Uniklinik RWTH Aachen: Universitatsklinikum Aachen