Abstract
Objective
A patient with fractured catheter in the distal tibial artery was successfully retrieved using balloon-assisted traction.
Key Steps
1) Detect the fracture and dislodgement of the catheter; 2) under fluoroscopy, identify the route of dislodgement; 3) confirming the catheter had dislodged into the right lower limb, perform arterial angiography via puncture of a contralateral artery; 4) advance a guidewire through the fractured catheter, traversing its midsection to the distal end; 5) pass 1.5-mm Maverick2 balloon over the catheter and inflate it to 16 atm; and 6) secure and carefully retrieve the catheter.
Potential Pitfalls
In high-humidity regions, the storage conditions of catheters must be strictly controlled. Moreover, the fragility of catheters should be thoroughly assessed in vitro prior to surgery to minimize the risk of vascular embolism and ischemia.
Take-Home Message
Balloon capture of the fractured catheter can be considered an effective method for removing fractured catheters in the distal and small arteries.
Key words: balloon-assisted traction, fractured catheter, interventional therapy, tibial artery
Graphical Abstract
Image
Interventional therapy/digital subtraction angiography (DSA).
Case Summary
A 12-year-old child with an atrial septal defect underwent a percutaneous intervention. During the procedure, the catheter unexpectedly fractured and migrated into the distal tibial artery. Runthrough guidewire (Terumo Corporation) was advanced to the tibial artery, traversing the midsection of the fractured catheter to its distal end. Subsequently, a 1.5-mm Maverick2 balloon was introduced over the catheter and inflated to 16 atm. The fractured catheter was secured and retrieved through the left femoral artery.
Interventional therapy is a widely adopted, minimally invasive treatment method for atrial septal defect (ASD). Compared to occluder dislodgement, catheter fracture and dislodgement are relatively rare but serious complications. They pose significant challenges for removal in smaller and more distal vessels. Here, we reported a case of a patient with a fractured catheter in the distal tibial artery, which was successfully retrieved using balloon-assisted traction.
A 12-year-old child was admitted to our hospital with ASD and underwent an interventional procedure under general anesthesia. During the procedure, a 5-F vertebral catheter (APT Medical) (Figure 1A) was advanced through the ASD into the left atrial and left pulmonary vein. Under fluoroscopy, the tip of the catheter suddenly fractured and migrated into the left ventricle (Figures 2A and 2B, Video 1). Despite attempts to secure and capture the fractured catheter tip within the ventricle, it suddenly escaped from the ventricle (Video 2). After excluding the possibility of embolization to the cerebral vessels, the catheter was identified in the right lower limb, specifically in the right distal tibial artery, as confirmed by arterial angiography during the procedure (Figures 2C and 2D, Video 3). However, the vessel was too small for the snare to reach, and surgical excision would be highly risky and traumatic for the child due to the deep muscle location.
Figure 1.
The Details of the Catheter
(A) The information of the 5F vertebral catheter. The red arrow indicated the validity period is July 20, 2026. (B) The catheter was easily fractured outside the body. The red arrows indicated the fractured catheter.
Figure 2.
The Image During the Procedure
(A) The tip of the catheter fractured in the left pulmonary vein. (B) The tip of the catheter fractured migrated into the left ventricle. (C) The fractured catheter was founded in the right lower limb. (D) The fractured catheter was confirmed in the right distal tibial artery by the arterial angiography. (E) The guidewire passing through the middle part of the fractured catheter to its distal end. (F) The balloon was passed over the catheter and inflated. (G) The fractured catheter was carefully retrieved. (H) The scan of the lower limb arteries without stenosis or injury. The red-colored arrows indicated the fractured catheter.
The left femoral artery was subsequently punctured, and a Runthrough guidewire was advanced to the right tibial artery, passing through the middle part of the fractured catheter to its distal end (Figure 2E, Video 4). After a 1.5-mm Maverick2 balloon (Boston Scientific Corporation) was successfully passed over the catheter, it was inflated to 16 atm (Figure 2F). Subsequently, the fractured catheter was meticulously secured and carefully retrieved through the left femoral artery (Figure 2G, Videos 5 and 6). Postintervention imaging of the lower limb arteries showed no evidence of stenosis or injury (Figure 2H).
Catheter fracture is an extremely rare complication during congenital heart intervention. In this case, the humid climate caused the catheter to become brittle, resulting in a fracture under slight pressure (Figure 1B, Video 7). This highlights the importance of strictly managing catheter-storage conditions in high-humidity regions and conducting in vitro assessments of catheter fragility before interventions to minimize such complications. In addition, the catheter was visible under fluoroscopy and was aligned parallel to the vessel, with a size almost identical to that of the vessel. This optimal positioning and sizing allowed for seamless navigation of the wire through the catheter, ensuring the wire technique worked effectively. If it had not been possible to pass or inflate a balloon, a micro snare could have been passed on the wire and used as an alternative technique.
Funding Support and Author Disclosures
The article was supported by “The Guangdong-Macau Youth Talent Two-way Exchange Program” (Grand number: 207145746053). The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
Footnotes
The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the Author Center.
For supplemental videos, please see the online version of this paper.
Contributor Information
Ji-yan Chen, Email: CJYcardiology@126.com.
Xiao-fei Jiang, Email: zhcardiology@126.com.
Appendix
The Catheter Advanced Through the Atrial Septal Defect Into the Left Pulmonary Vein and Fractured
The Fractured Catheter Migrated Into the Left Ventricle
The Fractured Catheter Was Confirmed in the Right Distal Tibial Artery
The Guidewire Passed Through the Middle Part of the Fractured Catheter to its Distal End
The Balloon Inflated and Retrieved the Fractured Catheter
The Fractured Catheter was Successfully Removed From the Body
The Catheter Became Brittle Under Slight Pressure In Vitro
Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Supplementary Materials
The Catheter Advanced Through the Atrial Septal Defect Into the Left Pulmonary Vein and Fractured
The Fractured Catheter Migrated Into the Left Ventricle
The Fractured Catheter Was Confirmed in the Right Distal Tibial Artery
The Guidewire Passed Through the Middle Part of the Fractured Catheter to its Distal End
The Balloon Inflated and Retrieved the Fractured Catheter
The Fractured Catheter was Successfully Removed From the Body
The Catheter Became Brittle Under Slight Pressure In Vitro