Occurrence and Management Strategies for Catheter Entrapment with Onyx Liquid Embolization

Abstract

In June 2012, Food and Drug Administration (FDA) issued a warning about the risk of catheter entrapment
associated with Onyx embolization. We used our experience, literature review, and FDA Manufacturer and
User Facility Device Experience (MAUDE) data review to identify five strategies to address catheter
entrapment: 1/. Surgical resection of vessel at point of entrapment of catheter and retraction from exterior
portion at the femoral region; 2/. Advancing and closing the loop of snare over the entrapped catheter followed by retraction; 3/. Advancing the distal access catheter over the entrapped catheter and retraction with
forward movement of the distal access catheters; 4/. Inflation of balloon catheter coaxial to the entrapped
catheter with subsequent retraction; and 5/. Intravascular retention and internalization of microcatheter. In
the MAUDE data, there were 77 reports of catheter entrapment with Onyx embolization; microcatheter was
retracted by surgical excision in 15, endovascular snare or other retriever devices in 5, deliberately entrapped inside the vessel using stent in 1, and left without intervention within intravascular compartment in 27
patients.