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10 - Knotted catheter in the brachial artery: when to perform surgery?
Kudret Keskin, Ahmet Gürdal, Hakan Kılcı, Gökhan Aksan, Murat Başkurt
Objective: Catheter knotting is a rare complication of coronary angiography. Treatment is controversial and differs from one laboratory to another.
Case: A 79 year-old patient was taken to the catheterization laboratory for diagnostic coronary angiography. Right coronary artery couldnt be cannulated with 5-F JR4 diagnostic catheter due to severe subclavian artery tortuosity. After several clockwise and counterclockwise maneuvers, a catheter knot was formed in the brachial artery region. Due to multiple unsuccessful attempts for retrieval, the patient experienced severe forearm pain which led to discontinuation our maneuvers. Therefore, we decided to perform surgery for removal of the catheter. We pulled the catheter slowly until the knot reached the tip of the sheath. The knot being in the radial artery, a surgical arteriotomy was performed safely under local anesthesia.
Conclusion: When all efforts fail, surgery can still be performed safely. In that situation, pulling the knot back into the radial artery should be tried vigorously
Keywords: Catheter knot, complication, transradial angiography
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