# Complex port removal: balloon-assisted retrieval of retained intravascular catheters – a technical note

## TL;DR

A balloon-assisted technique effectively removes difficult-to-extract long-term port-a-cath catheters with complications like fibrosis and calcification.

## Contribution

Demonstrates balloon-assisted retrieval as a primary method for removing complex retained port-a-caths.

## Key findings

- Balloon-assisted retrieval successfully removed 12 retained port-a-cath catheters with fibrotic and calcified adhesions.
- The technique caused minimal blood loss and no complications in all cases.
- It is effective for catheters with stenosis and should be considered a primary retrieval option.

## Abstract

Balloon dilatation has remained relatively underutilized despite its emerging potential for hemodialysis catheter removal. This case series revisits balloon-assisted retrieval to showcase its effectiveness in retrieving long-term port-a-caths complicated by fibrotic encapsulation, calcification, and stenosis.

Endoluminal balloon-assisted retrieval was utilized in 12 cases with retained port-a-cath catheters after gentle traction failed to remove the indwelling 8 French catheter due to complex intravascular fibrotic adhesions and calcifications. Under fluoroscopic guidance, a non-compliant angio-balloon was advanced over a guidewire through the externally accessible central venous catheter. Once the balloon reached the distal segment of the tubing, it was sequentially inflated in a retrograde manner within the catheter's lumen to disrupt the surrounding adhesions.

Balloon-assisted retrieval was successfully performed in all 12 cases, allowing for the complete removal of the indwelling catheter via gentle traction despite significant fibrotic encapsulation, calcification, and stenosis. Minimal blood loss was observed, and no further complications were reported.

This case series revisits endoluminal balloon dilatation, an emerging technique for removing hemodialysis catheters, to demonstrate its application and efficacy in retrieving long-term port-a-cath catheters complicated by fibrotic encapsulation, calcification, and stenosis. This technique should be regarded as a primary retrieval option for retained port-a-caths in instances of severe fibrosis and calcification.

Level 4, case series.