PDF(Pubmed)
Abstract：
BACKGROUND: The Chiari network, a remnant of fetal anatomy, consists of a mesh-like structure within the right atrium. With advancements in cardiac interventions, complications associated with the Chiari network have increasingly been reported. However, there are few reports about guidewire or catheter entrapment in the Chiari network during the insertion of a dialysis catheter.
METHODS: A 46-year-old male with end-stage renal disease was hospitalized and underwent a digital subtraction angiography-assisted catheterization of the right internal jugular vein tunnel-cuffed dialysis catheter. When the guide wire entered a depth of about 20 cm, it was difficult to advance, manifested as resistance when twisting the guide wire and inability to enter the inferior vena cava. After the peelable sheath was inserted, it was difficult to pull out the guide wire. After repeated attempts to rotate the guide wire, the guide wire was finally pulled out. A fibrous tissue was wrapped around the tip of the guide wire. Its length was 6 cm, with a smooth surface and tough texture. We considered that the tissue we pulled out was most likely a part of a Chiari network.
CONCLUSIONS: This case highlights the potential for the Chiari network to complicate surgical procedures, including difficulty with guidewire and catheter manipulation. Attention should be paid to Chiari networks. Echocardiography can be used to identify the Chiari network. During the surgery, forcefully pulling out a stuck guidewire is not suggested, to avoid the risk of tearing the atrial wall and causing pericardial tamponade. An urgent consultation with ultrasound doctors and cardiac surgeons might be helpful in such cases.
METHODS: A 46-year-old male with end-stage renal disease was hospitalized and underwent a digital subtraction angiography-assisted catheterization of the right internal jugular vein tunnel-cuffed dialysis catheter. When the guide wire entered a depth of about 20 cm, it was difficult to advance, manifested as resistance when twisting the guide wire and inability to enter the inferior vena cava. After the peelable sheath was inserted, it was difficult to pull out the guide wire. After repeated attempts to rotate the guide wire, the guide wire was finally pulled out. A fibrous tissue was wrapped around the tip of the guide wire. Its length was 6 cm, with a smooth surface and tough texture. We considered that the tissue we pulled out was most likely a part of a Chiari network.
CONCLUSIONS: This case highlights the potential for the Chiari network to complicate surgical procedures, including difficulty with guidewire and catheter manipulation. Attention should be paid to Chiari networks. Echocardiography can be used to identify the Chiari network. During the surgery, forcefully pulling out a stuck guidewire is not suggested, to avoid the risk of tearing the atrial wall and causing pericardial tamponade. An urgent consultation with ultrasound doctors and cardiac surgeons might be helpful in such cases.
摘要：
背景：Chiari网络，胎儿解剖结构的残余部分，由右心房内的网状结构组成。随着心脏干预的进步，与Chiari网络相关的并发症的报道越来越多.然而,在插入透析导管时,很少有关于Chiari网络中导丝或导管截留的报道.
方法：一名患有终末期肾病的46岁男性住院，并接受了数字减影血管造影辅助的右颈内静脉隧道袖套透析导管插入术。当导丝进入约20厘米的深度时，很难推进，表现为扭转导丝时的阻力和无法进入下腔静脉。插入可剥离鞘后，很难拔出导丝。反复尝试旋转导丝后，导丝终于被拔出。纤维组织缠绕在导丝的尖端周围。它的长度是6厘米，具有光滑的表面和坚韧的纹理。我们认为我们取出的组织很可能是Chiari网络的一部分。
结论：这个案例突出了Chiari网络使外科手术复杂化的可能性，包括导丝和导管操作困难。应该注意Chiari网络。超声心动图可用于识别Chiari网络。在手术过程中,不建议强行拉出卡住的导丝，以避免撕裂心房壁和引起心包填塞的风险。在这种情况下，与超声医生和心脏外科医生的紧急咨询可能会有所帮助。
方法：一名患有终末期肾病的46岁男性住院，并接受了数字减影血管造影辅助的右颈内静脉隧道袖套透析导管插入术。当导丝进入约20厘米的深度时，很难推进，表现为扭转导丝时的阻力和无法进入下腔静脉。插入可剥离鞘后，很难拔出导丝。反复尝试旋转导丝后，导丝终于被拔出。纤维组织缠绕在导丝的尖端周围。它的长度是6厘米，具有光滑的表面和坚韧的纹理。我们认为我们取出的组织很可能是Chiari网络的一部分。
结论：这个案例突出了Chiari网络使外科手术复杂化的可能性，包括导丝和导管操作困难。应该注意Chiari网络。超声心动图可用于识别Chiari网络。在手术过程中,不建议强行拉出卡住的导丝，以避免撕裂心房壁和引起心包填塞的风险。在这种情况下，与超声医生和心脏外科医生的紧急咨询可能会有所帮助。
