Abstract
BackgroundUnretrievable foreign bodies are associated with high morbidity and mortality. While the majority of reported cases involve the venous circulation, intra-arterial foreign body displacement have the potential to migrate more distally with a higher risk for dissection and hemorrhagic complications during retrieval. As the number of intravascular procedures continues to increase, there is also likely to be a concomittant increase in the number of retrieval procedures, particular for fractured catheters and sheaths. Although snaring is frequently the traditional, ‘go-to’ method for retrieval, there are inherent risks of further dislodgement or fracture.Case reportWe describe a case that involves retrieval of a fractured sheath that originated in the common femoral artery but migrated into the popliteal artery. Different retrieval approaches were employed, however ultimately balloon assisted, over-the-wire retrieval was the successful approach.ConclusionsWe anticipate that over-the-wire, inline-retrieval approaches will continue to grow in popularity and use, particularly with respect to manipulation within the arterial circulation.
Highlights
Unretrievable foreign bodies are associated with high morbidity and mortality
Intravascular foreign body dislodgement and embolization is a potential complication of any percutaneous image-guided procedure
In this case presentation we describe retrieval of a fragmented vascular sheath that migrated into the peripheral arterial system
Summary
Intravascular foreign body dislodgement and embolization is a potential complication of any percutaneous image-guided procedure. While loop snaring is frequently employed for foreign object retrieval, this technique is suboptimal when the foreign object does not have traction or is at risk for fragmentation. In this case presentation we describe retrieval of a fragmented vascular sheath that migrated into the peripheral arterial system. The dislodged sheath tip migrated past the right popliteal artery and into the tibioperoneal trunk (Fig. 4). At this point the retrieval strategy was changed and the dislodged sheath tip was cannulated with a 0.014′′ Hi-Torque Balance Middleweight (BMW) guidewire (Abbott Vascular, Santa Clara, CA), enabling
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