Introduction:This video demonstrates the challenging case of the retrieval of a fractured and embolized venous component of a HeRO graft within the left thoracic outlet using a hybrid technique.
Case description: The patient was a 36 year old female with a complex dialysis access history who was referred to our institution after a chest x-ray performed in an outside facility for a pneumonia revealed a fractured and embolized HeRO catheter in the chest.The preoperative CT scan demonstrated a venous component of HeRO fractured within the left thoracic outlet with distal embolization into the right atrium. CT scan also revealed a central venous catheter with the tip positioned in the azygous vein.
Surgical Management: Attempts to retrieve the catheter endovascularly using a groin approach was unsuccessful due unfovarable anatomy. Successful retrieval was subsequently achieved through an infraclavicular approach, necessitating a medial claviculectomy to expose the left subclavian vein. Direct puncture of the vein was achieved and an .035 wire used to cannulate the embolized component of the graft. Next a 5mm mustang balloon was introduced and inflated to serve as an anchor to retrieve the device.
Conclusion: A hybrid technique is feasible for retrieving fractured catheters within challenging anatomy