AFRICA CARDIOVASCULAR JOURNAL OF AFRICA • SMC-PAFCIC Abstracts October 2022 54 Submission ID: 1677 SUCCESSFUL RECOVERY OF CENTRAL VENOUS CATHETER FRAGMENT FROM THE RIGHT ATRIUM AND RIGHT VENTRICLE ABDELJELIL FARHATI, ZEINEB OUMAYA, ZEYNAB JEBBERI, FATHIA MGHAIETH, AMINE BOUSSEMA, MANEL BEN HALIMA, MOHAMED SAMI MOURALI TUNISIA Background: Central venous catheters are frequently implanted for chemotherapy and parenteral nutrition. When most commonly implanted in the subclavian vein (SCV), the venous catheter is subject to fracture because of the shear forces between the clavicle and the first rib. According to Cheng et al., broken catheters embolize frequently to superior vena cava (23.9%), right atrium-inferior vena cava (20.6%), right atrium-hepatic vein (11.9%), and right atrium- right ventricle (10.8%). Fig 1: X Ray Chest showing severed chemoport. Fig 2: X Chemoport catheter lodged partly in RA and partly in RV. Case: A 53-year-old woman, with right breast cancer mastectomy, was receiving adjuvant chemotherapy through a ventral venous catheter placed in the left SCV. The radiologic control confirmed the absence of signs of mechanical compression of the catheter and the correct position of its distal tip. Its optimal functioning had not motivated further radiological imaging. Two years later, in agreement with the oncology team, it was decided to explant the catheter. However, the chest X-ray before removal showed the presence of the distal fragment of the ruptured catheter in the right atrium (RA) and the right ventricle (RV). The extraction of this fragment was performed in the cardiac interventional unit. The right femoral vein was punctured under local anesthesia and a 6 F sheath was inserted. An effort was made with a snare to catch the right atrium end of the embolized catheter without success. After several attempts with snare, we took recourse to a pigtail catheter with which we could catch and straighten the RA end of the catheter into IVC, using a coronary guidewire wrapped through the pigtail around the fractured catheter and captured by a snare. This position was favorable for grasping the tip of the catheter using the snare device. It was then trapped using a loop snare. Then the whole assembly of the snare, captured catheter fragment, and 6 F sheath were pulled out in unison. The patient well tolerated the procedure without any complications. Conclusion: Thrombosis, embolism, arrhythmia, endocarditis, or sepsis were the fatal complications that may develop due to the fracture and migration of the port catheter. To prevent these complications, extraction of the fragment must be carried out. We report this case to make oncologists aware of this entity and the necessity of monitoring by chest radiography. Percutaneous endovascular retrieval of a dislodged catheter is both safe and effective. Fig 3: Attempt to snare with One snare device. Fig 4: Attempt to catch and straighten catheter fragment with Pig-tail catheter. Fig 5: AV end of the catheter was being caught and straightened. Fig 6: IVC end of the catheter was seized by Snare. Fig 7: Extracted catheter fragment of Chemoport. MODERATED POSTER SESSION
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