PMC5385326_01
After contrast media injection, a small pouch of contrast is visible at the tip of the catheter as long as a retrograde contrast tracking along the catheter (arrows), indicating fibrin sheath formation.
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F1
We evaluated the catheter by injecting a contrast media via the injection port under fluoroscopy, which revealed reflux with a small pouch of opacification around the catheter tip suggestive of fibrin formation (Figure 1).
In order to remove the fibrin sheath, the Atrieve Snare was inserted through a Judkins-Left 4 catheter and deployed just distally to the tip.
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F2
The snare was deployed and manipulated in order to encircle the tip of IVAD. The JL4 catheter and snare were then withdrawn proximally in the SVC while maintaining the snare coils open (Figure 2).
Then, the snare was retrieved so as to encircle the catheter, and then it was loosely tightened proximally.
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F3
This is unlike the standard stripping technique via femoral approach where the snare is pulled back rather than pushed on the IVAD tip (Figures 3 and 4).
The snare was kept tightened, and then it was pushed toward catheter's tip in order to release fibrin. No port displacement is visible.
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F4
This is unlike the standard stripping technique via femoral approach where the snare is pulled back rather than pushed on the IVAD tip (Figures 3 and 4).
Implanted venous access device opacification after fibrin sheath removal shows normal flow at the catheter tip.
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F5
After two stripping maneuvers, injection of contrast media via the IVAD injection port did not demonstrate any reflux along the device catheter (Figure 5), and hence, adequate blood flow via the IVAD was reestablished.