Transvascular removal of catheter fragments from the great vessels and heart.

Embolization of catheter fragments or fractured spring guidewires used during cardiac catheterization or fractured central venous pressure (CVP) lines is not uncommon. Although CVP lines are usually used in seriously ill patients, often with complications secondary to prior surgical intervention, if the catheter fragments are not removed they can give rise to serious illness or death in about 50% of patients. Experience with the removal of nine such catheter fragments is reported. In eight patients a helical basket was available for removal through a Dotter retrieval catheter. With prolonged hyperalimentation therapy polyethylene catherters become very brittle. They are relatively easy to grip with the wire basket. Silicone elastomer catheters remain pliable but are so bouncy that they are difficult to grip. For removal of catheter fragments from vessels of small diameter, such as the subclavian vein, or vessels in which the catheter has to take an acute bend to enter, such as the right or left pulmonary artery, a smaller, more pliable Bean-Smith-Mahorner biliary stone helical basket was adapted by extending the length of wire to 100 cm. For removal of catheter fragments from the right pulmonary artery it is probably better to use a softer, 100-cm-long no. 8 French right heart catheter. A Dotter retriever catheter set with both large and small helical wire baskets should be available in any cardiac catheterization laboratory.