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Acute Limb Ischemia Secondary To Entrapped Intra-arterial Microcatheter
Brendon Reilly, MD1, Danielle Thesier, MD1, Gregory Clabeaux, DO2, Aimee Swartz, MD2, Paul Anain, MD2, Roger Walcott, MD2.
1University at Buffalo, Buffalo, NY, USA, 2Vascular and Endovascular Center of Western New York, Buffalo, NY, USA.

DEMOGRAPHICS62-year-old female with past medical history of hypertension, hyperlipidemia, DVT, and a dural arteriovenous fistula for which she has undergone embolization with N-butyl cyanoacrylate (NBCA) multiple times. Her most recent embolization was complicated by microcatheter entrapment within the NCBA at the embolization site, which was managed by cutting the catheter at the transfemoral access and leaving it in situ.
HISTORYThe patient presented 15 months after the index procedure with 3 days of progressively worsening right calf pain and foot numbness. Right pedal pulses were not palpable. A CTA demonstrated an intra-arterial foreign body with one end in the abdominal aorta and the other within an occluded popliteal artery. PLANThe patient was placed on systemic anticoagulation. A CT of the head and neck was obtained to assess for any evidence of other retained foreign body. An operative plan was made for femoral exposure, attempted foreign body retrieval, and revascularization of the extremity. After exposure and control of the femoral vessels, a transverse arteriotomy was created. The microcatheter was removed from within the common femoral artery. It came out easily and appeared to be intact. The right lower extremity was then revascularized with a combination of open and over the wire thrombectomy as well as angioplasty of the popliteal artery. In line flow was re-established through the popliteal artery and into the infrapopliteal system with two vessel runoff and a palpable dorsalis pedis pulse at the end of the operation. DISCUSSIONMicrocatheter entrapment following NBCA embolization is a known complication and its incidence has been reported to be between 1.6-11.6%. The standard of care in most cases is to leave the catheter in situ. Potential complications that have been reported include incorporation into arterial wall, thrombotic occlusion, and pseudoaneurysm formation. The case described is one of catheter migration and arterial occlusion manifesting as acute limb ischemia. The treatment plan resulted in successful revascularization of the limb and resolution of the patientís symptoms. Management of this problem varies by the arterial bed affected and by the patient presentation. Patients should be counseled on the possible long-term complications of entrapped microcatheters left in situ.


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