Interventional Removal of Large Catheter-Associated Thrombi Using a Self-Expanding Nitinol Basket

Background: Catheter-associated thrombi in permanent indwelling catheters (e.g., Hickman's catheters) lead to catheter malfunction and may be the basis for catheter-related infections. Due to the high risk of embolism, simple removal of such catheters is not possible and may require open surgical vascular access, as previous endovascular systems (e.g., cava filter) cannot be safely placed in the superior vena cava and do not ensure safe removal of thrombotic material. A novel self-expanding nitinol basket could remedy this situation.

Method: We report four patients with large catheter-associated thrombi. First patient: 3 years, short bowel syndrome, weighing 12 kg, and thrombus 7 mm × 28 mm. Second patient: 5 years, short bowel syndrome, weighing 15.7 kg, and thrombus 8 mm × 31 mm. Third patient: 2 years, hemophilia A, weighing 17 kg, and thrombus 3 mm × 7 mm. Fourth patient: 9 years, short bowel syndrome, weighing 21 kg, and thrombus 4 mm × 31 mm. In patient no. 4, interventional access was not possible because of thrombotic occlusion of the infrarenal inferior vena cava. In each of the other three patients, a 0.035-inch stiff exchange wire could be placed into the superior vena cava after sonography-guided puncture of the femoral vein. After visualization of the thrombus by KM administration via the Hickman catheter and prebougie of the femoral vein, a 10-Fr sheath with an internal nitinol catch basket was advances to the orifice of the superior vena cava. By advancement of the catch basket, the catch basket was open ended in the superior vena cava with collection of the thrombus and the catheter tip. By advancing the sheath, the catch basket with trapped thrombotic material was closed. After removal and cleaning of the catch basket, the procedure was repeated two times until all thrombotic material was safely removed.

Results: In three patients, long-distance, partially organized thrombi could be safely removed via a femoral venous access route. Thromboembolic complications were not seen with adequate heparinization and platelet aggregation inhibition.

Conclusion: With the described system, large and even organized thrombi can be safely removed. A disadvantage is the exclusively available 10-Fr size of the thrombectomy system. Here, a reduction in the size of the system would be desirable for use in children.

Publication History

Article published online:
12 February 2022