Bailout management of pull-line entrapment following Viabahn stent deployment: A case report

Abstract

Central venous occlusion is a prevalent cause of vascular access failure among hemodialysis patients, and endovascular treatment represents the preferred approach; however, intraoperative complications demand meticulous attention.¹ We report a case of a 69-year-old male patient with end-stage diabetic nephropathy who had been undergoing maintenance hemodialysis via a left wrist arteriovenous fistula for 3 years. He presented with swelling of the left upper limb and face due to left brachiocephalic vein occlusion and underwent percutaneous transluminal angioplasty in conjunction with covered stent implantation under digital subtraction angiography guidance. After full stent deployment, the pull line became trapped during its withdrawal. We resolved the complication by stabilizing the stent with an angiographic catheter, preventing displacement and vascular injury. Unlike previously reported bailout techniques that require specialized balloon stabilization, this method utilizes a standard 5 F angiographic catheter—a readily available device in most interventional suites—to stabilize the stent edge and facilitate pull-line retrieval. This approach offers a simpler, more accessible alternative for managing this rare complication, particularly in resource-limited settings. In conclusion, Viabahn stent deployment with entrapment of the pull line is a rare complication. When pull line entrapment occurs, this technique can effectively resolve the complication while minimizing the risk of stent migration and vascular injury, provided that resistance is not excessive. Careful fluoroscopic monitoring and readiness to abort the procedure if significant resistance is encountered are essential.