A 61-year-old female patient was referred to our hospital to undergo surgical resection of colon cancer. She underwent bilateral mastectomy for breast cancer and implantation of a central venous port system for chemotherapy 16 years ago in another institution. In addition, she has been suffering from pulmonary hypertension for 10 years. At the preoperative workup, a chest radiograph revealed a broken central venous catheter fragment in the heart. According to a retrospective review of the chest radiographs, disruption of the catheter occurred at least 3.5 years ago. The catheter fragment was found to be lodged mainly in the right atrium on computed tomography (CT), and both ends located in the right atrial appendage and the left hepatic vein were inaccessible (Figure 1).
Percutaneous retrieval of the catheter fragment was performed as follows: under local anesthesia, the right femoral vein was punctured and a 10-Fr sheath 25 cm in length (Supersheath®, Medikit Co. Ltd., Tokyo, Japan) was placed in the inferior vena cava (IVC). A 6-F snare catheter with a 25-mm-diameter loop (Amplatz Gooseneck SnareTM, Medtronic, Minneapolis, MN, USA) was advanced into the hepatic segment of the IVC and opened in advance. Then, an angled 4-F pigtail catheter (Optiflash®, Terumo Co., Tokyo, Japan) was inserted over a 0.035-in guidewire (Radifocus®, Terumo Co., Tokyo, Japan) into the sheath side-by-side with the snare catheter. The pigtail catheter was advanced into the right atrium passing through the snare loop under multi-directional fluoroscopic guidance (Figure 2a). The catheter fragment was then hooked and pulled inferiorly by the pigtail catheter (Figure 2b). As a result, the inferior end of the catheter fragment disengaged from the left hepatic vein and fell into the IVC through the snare loop (Figure 2c). Instantly, the snare loop tightened the catheter fragment at the initial position (Figure 2d). Repositioning of the snare catheter was not necessary throughout the procedure. When the catheter fragment was being removed from the body, the pigtail catheter was first pulled into the sheath to ensure sufficient clearance to pull the folded catheter fragment into the sheath. The administration of local anesthesia to the withdrawal of the sheath took 26 min. Fluoroscopy time was 4.6 min. The dose area product was 8640 mGycm2 and air kerma was 68.12 mGy.