Percutaneous Retrieval Research Articles

Extracción percutánea de un cuerpo extraño del ventrículo derecho. Caso clínico

Percutaneous retrieval of intravascular foreign bodies has emerged as a standard method of treatment, which audits major surgery. This procedure was performed in a patient with a fragment of a broken introducer sheath located in the right ventricle with risk of arrhythmias. Extraction was difficult because the sheath was trapped in the tendinous cords. The foreign body was embolized to the pulmonary artery and extraction was performed. No clinically significant complications occurred.

Percutaneous retrieval of a broken silastic catheter from the left atrium in a critically ill premature infant

Percutaneous retrieval of a broken silastic catheter from the left atrium in a critically ill premature infant

Fertility options after vasectomy: A cost-effectiveness analysis

To evaluate cost per delivery using two different initial approaches to the treatment of postvasectomy infertility. Model of expected costs and results in the United States in 1994. Men with postvasectomy infertility, evaluated and treated at centers with experience in vasectomy reversal or sperm retrieval and ICSI. Men with postvasectomy infertility, with a female partner < or = 39 years of age. Initial microsurgical vasectomy reversal was compared with retrieved epididymal or testicular sperm. Actual treatment charges, complication rates, and pregnancy and delivery rates obtained in the United States were used for cost per delivery analysis. Cost per delivery, delivery rates. Cost per delivery with an initial approach of vasectomy reversal was only $25,475. (95% confidence interval $19,609 to $31,339), with a delivery rate of 47%. However, the cost per delivery after sperm retrieval and ICSI was $72,521. (95% confidence interval $63,357 to $81,685), with an average of $73,146 for percutaneous or testicular sperm retrieval and $71,896 for surgical epididymal sperm retrieval. The delivery rate after one cycle of sperm retrieval and ICSI was 33%. The most cost-effective approach to treatment of postvasectomy infertility is microsurgical vasectomy reversal. This treatment also has the highest chance of resulting in delivery of a child for a single intervention.

Percutaneous Transfemoral Retrieval of a Partially Deployed Simon-Nitinol Filter Misplaced into the Ascending Lumbar Vein

Percutaneous Transfemoral Retrieval of a Partially Deployed Simon-Nitinol Filter Misplaced into the Ascending Lumbar Vein

Complex biliary stones: treatment with a small choledochoscope and laser lithotripsy.

To evaluate the use of a small choledochoscope and laser lithotripsy in the treatment of complex biliary stone disease. Twenty-five consecutive patients with complex biliary stone disease not amenable to surgical therapy, peroral endoscopic removal, or simple percutaneous retrieval techniques underwent 35 stone-removal procedures. A 3.4-mm endoscope and a pulsed dye coumarin green laser were used to pulverize and remove stones through preexisting, mature transhepatic biliary drain tracts (n = 18), t-tube tracts (n = 3), cholecystostomy tube tracts (n = 3), and a hepaticocutaneous enterostomy (n = 1). Procedures in 14 of the 25 patients (56%) were performed on an outpatient basis. Twenty-four of the 25 patients (96%) were cleared of their stone burden and underwent subsequent catheter therapy of strictures or abscesses as necessary. Complications of the stone removal included fever and chills in six patients (24%) and mild bleeding from a bile duct wall during removal of an adherent stone in one patient. Use of a small choledochoscope and a coumarin green pulsed dye laser is safe and effective in the management of complex biliary stone disease.

Percutaneous retrieval of a Vena-Tech filter displaced during central line placement.

Percutaneous retrieval of a Vena-Tech filter displaced during central line placement.

Case report: Percutaneous retrieval of gunshot pellet emboli from the crural arteries

Case report: Percutaneous retrieval of gunshot pellet emboli from the crural arteries

Percutaneous retrieval of a broken pacemaker fragment from the superior caval vein in a child

SummaryThe increase in use of endovascular devices in the treatment and diagnosis of malformations of the cardiovascular system has created a need for another device suitable for retrieval of dislodged catheters or fragments in children. We describe the use of a snare made of nickel-titanium (nitinol) cable for retrieval of a broken pacemaker electrode lodged in the superior caval vein.

Fluoroscopically-guided retrieval of ureteric stents

Percutaneous fluoroscopically-guided retrieval of seven dysfunctional ureteric stents was performed in five patients (four male, one female) over an 18 month period. The technical aspects of the procedure are discussed and the preferred method using rigid forceps is described.

Functional and structural characteristics of human epididymal spermatozoa retrieved by transcutaneous aspiration.

The present paper describes the development of a simple, repeatable technique for transcutaneous aspiration of epididymal spermatozoa in patients with inoperable excretory azoospermia. Some functional and structural parameters of the retrieved spermatozoa were also evaluated. Epididymal spermatozoa from patients and ejaculated spermatozoa from fertile donors showed similar percentages of acrosome-reacted cells after incubation for 6 or 15 h in capacitating medium. Penetration of zona-free hamster oocytes, expressed as the percentage of penetrated ova, was significantly lower (p < 0.01) for spermatozoa from patients than for ejaculated spermatozoa from fertile donors. The percentage of epididymal spermatozoa with stable nuclei in sodium dodecyl sulphate was lower (p < 0.001) than for ejaculated spermatozoa from fertile donors. A positive linear correlation (r = 0.74, p < 0.005) was evident between the oocyte penetration rate and the percentage of spermatozoa with stable nuclei. In conclusion the percutaneous retrieval of epididymal spermatozoa in excretory azoospermia allows collection of motile spermatozoa, which can be evaluated for their structural and functional characteristics before repetition of the technique for retrieval of spermatozoa for assisted fertilization techniques.

Percutaneous Retrieval of Two Wallstent Endoprostheses from the Heart through a Single Jugular Sheath

O SCVIR, 1995 The rapidly expanding use of endovascular devices has necessitated new techniques to remove misplaced or migrated devices. Percutaneous removal of a single Wallstent with use of a combined femoral and jugular vein approach has been described previously (1). The present case demonstrates successful percutaneous retrieval of two Wallstents, one from the right atrium and one from the tricuspid valve, via a single preexisting sheath in the internal jugular vein (IJV).

Retrievable IVC Filter: Preliminary in Vitro and in Vivo Evaluation

To develop an inferior vena cava (IVC) filter that is retrievable even after neointimal formation and incorporation into the caval wall. Eight filters were placed percutaneously in the infrarenal IVC of eight dogs. Four weeks after placement, percutaneous retrieval of the filters was attempted. Vena cavograms were obtained before and immediately after retrieval. Three dogs were killed immediately after the retrieval procedure was completed. In the other five dogs, follow-up vena cavography was performed 4-14 weeks after retrieval, and autopsy was performed. The filters were placed and retrieved successfully in all eight dogs. No migration, caval penetration, or tilting occurred. The IVCs were completely patent both before and immediately after retrieval in all eight dogs. In the three dogs killed immediately after retrieval, neointimal hyperplasia was seen around the struts, but there was no detachment. Delayed stenosis was not seen in any of the five dogs that were followed up, and the inner surface of the caval wall was smooth. This IVC filter can be easily placed and safely retrieved percutaneously, even after neointimal formation.

Retrieval of intravascular foreign bodies: experience in 32 cases.

Recent reports suggest that both the nature of intravascular foreign bodies and the tools available to retrieve them have changed substantially in the past decade. We reviewed our recent experience with percutaneous retrieval of intravascular foreign bodies to determine the efficacy and safety of the procedure using currently available devices. Between 1990 and 1994, we attempted retrieval of 35 intravascular foreign bodies in 32 patients. Twelve patients (38%), including all five with intraarterial foreign bodies, were treated for complications of transcatheter interventional procedures that resulted in embolization of seven coils, four intravascular stents, an inferior vena cava filter, and a valvuloplasty balloon fragment. From procedure records, we reviewed the types of retrieval devices and methods used; the medical record was studied to determine the occurrence and treatment of any procedure-related complications. Retrieval was successful in 31 (97%) of 32 patients. All five intraarterial and 29 of 30 IV objects were removed. Nitinol goose-neck snares were used in 28 of 32 cases, but more than one retrieval system was required in eight cases (25%), often using grasping forceps, tip-deflecting wires, or stone baskets to move the foreign body into a more favorable position for snaring. In the single failure, the tip of a largely extravascular catheter fragment lay in a venous valve and could not be snared in a patient who refused surgery. Two of five patients with arterial foreign bodies suffered occlusive arterial spasm, reversible with local administration of nitroglycerine. Two large objects were repositioned to the femoral vein and removed by surgical cutdown. No other procedural complications occurred, and none of the patients required additional compression, transfusion, or surgical intervention. We conclude that use of preformed nitinol goose-neck snares facilitates retrieval of intravascular foreign bodies in most cases, although interventional radiologists must be familiar with a variety of techniques to deal with the expanding spectrum of foreign bodies currently encountered.

773-6 Initial Human Implants with a Flexible Radio-Opaque Tantalum Stent

To address limitations of current stent technology a radio-opaque, tantalum stent using a novel continuous zig zag helical coil has been developed, undergone successful animal investigations prompting initial human implants. The target lesions were restenotic in a large (&gt;3 mm reference diameter) vessel in single vessel disease. Between February 8 and June 22. 22/23 (96%) patients underwent successful single stent implantation. The patients were mostly male (17) mean age 61 yrs with single restenosis in 16 and multiple restenoses in 7. The target vessel was the LAD in 11. RCA in 10 and circumflex in 2. Stent visibility was graded as excellent in 18 and good in 5. Initial stent sizing was 3.0 in 15, 3.5 in 8 with a mean max inflation pressure of 12.8 ATM. There was a single delivery failure with stent embolization and subsequent percutaneous retrieval. There was one in-hospital Q wave infarct due to nonocclusive thrombus on day 2. There were no other major complications. Three patients had vascular complication (2 pseudoaneurysm, 1 bleed requiring transfusion). There were no out of hospital subacute thromboses; exercise treadmill at 6 weeks was negative in all patients.Empty CellPre PTCAPost PTCAPost StentMLD mm0.60 ± 0.07*1.57 ± 15*296 ± 0.21% Stenosis80.6 ± 2.3*33.3 ± 37*–0.63 ± 1.98*p &lt; 0.001 p &lt; 0.001 Preliminary human implants confirm the favourable design and delivery system with the distinct advantage of access to and preservation of side branches, delivery with a high pressure balloon and low profile delivery system. Long term randomized studies will be required to determine the future role of this stent.

Percutaneous retrieval of an impacted ureteric T-tube

An impacted ureteric T-tube was removed percutaneously, using an Amplatz “goose-neck” snare. This new snare has advantages over conventional snares, particularly in situation where atraumatic manipulation is essential.

Non-surgical retrieval of intravascular foreign body: experience of 12 cases

An intravascular foreign body is an iatrogenic complication that occurs during arterial or venous catheterization or interventional procedures. The foreign body could either be a catheter fragment, a dislodged coil, or a steel guide wire. From January 1987 to December 1992, 12 cases of intravascular foreign-body removals were performed by a percutaneous method at Mackay Memorial Hospital. Of the 12 cases, five were dislodged steel guide wires, four were broken CVP catheters, two were dislodged coils, and one was Port-A fragment. The techniques we used were the loop-snare technique (two cases) and stone basket retriever (10 cases). Eleven cases of intravascular foreign bodies were removed by non-surgical percutaneous retrieval but one case was a failure due to improper extraction of a dislodged steel guide wire. The patient received surgical extraction by regional venotomy finally. No major complications were noted during or after these procedures.

Percutaneous Retrieval of Foreign Bodies: Experience with the Nitinol Goose Neck Snare

The authors present their experience with the nitinol Goose Neck snare system in the retrieval of retained foreign bodies in 20 patients. Foreign bodies were located in the vascular system in 13 patients, urinary tract in four, biliary system in one, gastrointestinal tract in one, and the peritoneal space in one. All retrievals were performed with use of standard angiographic/interventional techniques. Success was achieved in all cases without attendant complications. Foreign bodies removed included catheter and guide-wire fragments, an embolization coil, broken or occluded double pigtail catheters, a Wallstent, and a surgical laparotomy sponge. All procedures were performed quickly, safely, and without difficulty. Because of its excellent torque control, positive grasping capacity, excellent radiopacity, lack of traumatic effect, and availability in different sizes appropriate for use in a wide variety of difficult anatomic spaces, the authors recommend that this device be considered the first choice for all foreign body retrieval procedures.

Percutaneous Retrieval of a Large Palmaz Stent from the Pulmonary Artery

Percutaneous Retrieval of a Large Palmaz Stent from the Pulmonary Artery

Case report: Percutaneous retrieval of a misplaced embolization coil

We report a case of percutaneous retrieval of a misplaced embolization coil which threatened the segmental arterial supply of a single kidney. The renal artery was steeply angulated due to a spinal scoliosis but retrieval was rapidly performed using an Amplatz gooseneck snare. This device is particularly useful when the arterial anatomy is tortuous.

Percutaneous Transfemoral Retrieval of a Free-Floating Titanium Greenfield Filter with an Amplatz Goose Neck Snare

Percutaneous Transfemoral Retrieval of a Free-Floating Titanium Greenfield Filter with an Amplatz Goose Neck Snare