Surgical removal of a fractured balloon catheter from deep femoral artery: a case report | |
DOI: 10.5606/e-cvsi.2016.553 | |
Erdal Şimşek, Eren Günertem, İbrahim Erkengel, Serkan Mola, Gökhan Lafçı, Kerim Çağlı | |
Department of Cardiovascular Surgery, Türkiye Yüksek İhtisas Training and Research Hospital, Ankara, Turkey | |
Keywords: Deep femoral artery; fractured balloon catheter; pseudoaneurysm | |
An intravascular fracture of balloon catheters during peripheral catheterization is uncommon. This is a rare, but a serious complication of
interventional procedures, which may lead to bleeding or lower limb ischemia and require an emergency surgical intervention. Herein, we
present a 71-year-old male case in whom a balloon catheter was broken inside of the deep femoral artery and retrieved surgically. A broken
and entrapped catheter is one of the extraordinary complications in this type of applications. Fortunately, it is seen rarely and treated either
interventional or surgical techniques. |
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The percutaneous interventions are commonly used
in the treatment of peripheral vascular diseases.
There is a number of complications related to these
procedures. A fractured segment of angioplasty
balloon catheter in a peripheral artery is one of them.
Herein, we report a case in whom a balloon catheter
was broken inside of the deep femoral artery and
retrieved surgically. |
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CASE PRESANTATION
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A 71-year-old man was admitted our hospital with
a pain on the right inguinal area for a month after
a coronary intervention via the right femoral artery.
Doppler ultrasound confirmed a pseudoaneurysm
originating from the deep femoral artery, which was
measured 100x70x50 mm in size. An endovascular
treatment was planned. The interventionists placed
a covered stent across the hole in the arterial wall to
prevent blood flow from the deep femoral artery to the
pseudoaneurysm sac. However, it broke down from
the neck during retrieval of the balloon catheter. The
interventionists tried several attempts to snare it out;
however, all attempts failed. The patient was referred
to us for surgery. A written informed consent was
obtained from the patient. Following the skin incision,
a large hematoma was seen and, then, drained. The
common femoral artery and distal portion of the deep
femoral artery were freed with careful dissection and
nylon tapes were placed around the vessel (Figure 1).
The broken end of the balloon catheter was seen into
the deep femoral artery and removed (Figure 2). The artery was, then, repaired with 6-0 prolene sutures.
The procedure was performed under local anesthesia.
After surgery, the patient was followed for three days
in the ward and, then, he was discharged. |
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The percutaneous interventions are routinely being
used worldwide for the management of peripheral
vascular diseases such as stenosis, arteriovenous fistulas
or pseudoaneurysm. However, there is a number of
complications which may arise during this process.
A fractured segment of angioplasty balloon catheter
in a peripheral artery poses the risk of undesired
complications, such as bleeding or acute embolism,
leading to lower limb ischemia.[1] Non-surgical retrieval of broken catheters has been reported and most of them were totally localized in the intravascular space.[2,3] Earlier, ultrasound was used to show the location and size of any radiolucent foreign body and percutaneous retrieval of nonopaque foreign bodies were carried out under the ultrasound guidance.[4] In this case, retrieval of a broken catheter was performed surgically, although interventional methods were tried before surgery. Furthermore, the selection of an optimal catheter material and appropriate size is critical. Improper entry point on the vessel can cause serious complications. In our case, the interventionists put the sheath on the deep femoral artery. Choosing the common femoral artery for access could have reduced angulation on the neck of the catheter and prevented breakage. If catheter size is incompatible with the sheath size, the interventionist can face similar challenges. Therefore, using a longer sheath and choosing the common femoral artery for entry point would have been precluded this complication in our case. In recent years, interventional techniques have become widely adopted thanks to their easy-touse nature without pain and not requiring general anesthesia. In conclusion, although intravascular fractures of angiography catheters during peripheral catheterizations are rare complications, retrieval of a broken and entrapped catheter fragments may be possible with either interventional or surgical methods. Therefore, physicians should be aware of such problems and inform patients . We believe that this report will guide to physicians on how to manage this type of complication surgically.
Declaration of conflicting interests
Funding |
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1) Krajcer Z, Howell MH. Update on endovascular treatment
of peripheral vascular disease: new tools, techniques, and
indications. Tex Heart Inst J 2000;27:369-85.
2) Woodhouse JB, Uberoi R. Techniques for intravascular
foreign body retrieval. Cardiovasc Intervent Radiol
2013;36:888-97.
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