Retrieval Of Intravascular Foreign Bodies Research Articles

Percutaneous Transcatheter Retrieval of Central Venous Port Fragments in Pediatric Patients; A Single-center Experience From the Pediatric Cardiology Department.

Split/fracture and embolization of central venous/shunt catheters are rare but serious complications in children. Percutaneous retrieval of intravascular foreign bodies is an important minimal invasive treatment. This study is aimed to represent our largest pediatric sample experience till now of 17 years from a single institution. Another aim is to compare the results regarding the removal or leaving in place of embolized or ruptured intravascular or cardiac venous catheter parts in children. A total of 26 cases were included in this study. Any pediatric patient with normal coagulation parameters and a fractured catheter fragment was included in this study. Other intravascular foreign bodies related to interventional devices and/or pacemaker/implantable cardiac defibrillator leads were excluded from this study. Twenty-six patients, of whom 25 had oncologic diseases and 1 had a ventriculoatrial shunt, were included. The median age was 83.5 months (between 20 mo and 18 y) at treatment.Superior vena cava (9 cases), followed by the right atrium (5 cases), were the most two common sites of embolization for cardiovascular foreign bodies. The success rate of percutaneous retrieval was 92.3% in all patients. There were neither complications nor deaths. The retrieval technique revealed a predisposition for extraction through the femoral vein (96.1%) and using snare techniques (100%). Additional catheters like pigtail, National Institutes of Health, or ablation catheters were used for stabilization in selective cases in which the permanent central venous fragments stuck to the vessels. A tractional maneuver and capturing the ruptured material in the middle were other trick points for successful retrieval. Patients were asymptomatic in 76.9% of cases (20/26). Percutaneous retrieval of cardiovascular foreign bodies is a reasonable, safe, and effective way in children when the catheter fragments are free and mobile. It should be considered the preferred treatment option instead of surgery. In patients where catheter fragments are stuck and are adherent to vessels, it could be left, and followed up by anticoagulation. Novel techniques accompanied by an experienced team could be helpful in difficult cases.

Balloon-Assisted Retrieval of a Retained Vascular Sheath during Complex Inferior Vena Cava Filter Removal.

A potential complication of complex endovascular procedures is retained foreign bodies such as fragmented catheters, wires, stents, or sheaths in the intravascular space. Different techniques are available for retrieval of intravascular foreign bodies including snares, forceps, baskets, tip-deflecting wires, and balloon catheters. The aim of this article is to describe our experience in which a lost large intravascular sheath was retrieved using balloon assistance. We also provide a review of different techniques used for intravascular large sheath retrieval and methods to avoid this complication during endovascular procedures such as complex inferior vena cava filter removal.

Intravascular foreign body retrieval.

Intravascular foreign body (IFB) embolization is a potential complication of any vascular procedure. Intravascular foreign body retrieval (IFBR) can be achieved using percutaneous techniques, open surgery, or both combined. We completed a retrospective review of patients who underwent endovascular or open IFBR since 2011 on our institution. Primary end-point was technical retrieval success, and secondary end-points were procedure-related compli- cations and 30-days survival. Twenty-seven patients underwent IFBR. Median time from intravascular device loss and retrieval was less than one day. 67% were non-endovascular guidewires and sheath fragments (N=28). 59% of IFBs were lost during their deployment (N=16); 41% during their removal attempts (N=11). 44% were lost in the arterial system (N=12) and 52% in the venous system (N=14). An endovascular procedure was used as the first approach in IFBR in 56% of patients (N=15) and open procedure in 44% (N=12). In the presence of IFB on the thoracic or abdominal cavity, it was always tried a first-endo approach; if IFB was present on the neck or limbs, 75% were retrieved by open surgery (N=20; p<0.001). Success rates were 100% for open and 87% for endovascular procedures. IFB caused five acute complications: one IJV thrombosis, two strokes and three acute limb ischemia. There were no IFBR-related complications. 30 days-survival was 100%. Embolization of IFBs can be minimized with proper device selection, deployment and removal. In this study, open and endovascular retrieval had high success rates and minimal morbidity. Its choice is surgeon-dependent and restrained by devices availability.

Percutaneous retrieval of intravascular foreign body in children: a case series and review

Percutaneous retrieval of intravascular foreign bodies has recently increased as a treatment option. To report our single-center experience of the percutaneous retrieval of 14 intravascular embolized catheter fragments in children and to conduct a literature review. MEDLINE databases were searched for case reports and series including children and iatrogenic catheter fragments or guidewires retrieved through percutaneous techniques. We also conducted a retrospective analysis of 14 cases from our institution over a 14-year period. A total of 27 studies were selected comprising 74 children, plus our 14 unpublished cases. Statistical analyses were performed using Microsoft Excel version 2016. Port catheter fragments and peripherally inserted central catheters (PICCs) were the most embolized foreign bodies and the pulmonary artery was the most common site of embolization in 44.1% of cases. Analysis of the retrieval technique demonstrated a preference for extraction through the femoral vein (81.7%) and using snare techniques (93.5%). The success rate of percutaneous retrieval was 96.6% with only 1.1% of procedure-related complications. Patients were asymptomatic in 77.2% of cases, presented septic complications in 2.3%, and no deaths were reported. Median fluoroscopy time was 10 min (range = 1.7-80 min) and median procedure length was 60 min (range = 35-208 min). Percutaneous retrieval of intravascular foreign bodies is a feasible, safe, and efficient technique in children and should be considered the preferred treatment option.

Iatrogenic Intravascular Foreign Body Retrieval in a Neonate

AbstractThis is a short communication demonstrating a unique method of intravascular foreign body retrieval by grasp from inside technique in a neonate.

Materials and techniques for percutaneous retrieval of intravascular foreign bodies.

The presence of an intravascular foreign body represents a well-known risk of serious complications. While in the past surgical removal of intravascular foreign body was the most common intervention, nowadays a percutaneous approach in the retrieval of an intravascular foreign body is widely accepted as the first-line technique. In the literature, many case reports describe different techniques and materials. This article summarizes and illustrates the main materials and techniques currently applied for percutaneous retrieval of intravascular foreign body, providing a simplified tool with different interventional possibilities, adaptable to different clinical situations.

Balloon assisted retrieval of broken catheter in a 10-months old baby with patent ductus arteriosus: Case report

Percutaneous retrieval of intravascular foreign body can be done by snares, biopsy forceps, dormia basket or tip deflecting wires. Herein, we report percutaneous retrieval a fractured multipurpose diagnostic catheter by balloon assisted technique in a 10-months old baby while doing device closure of a patent ductus arteriosus. The catheter got fractured at the junction of shaft and the tip while manipulation to right ventricular outflow tract during antegrade wiring. The fractured proximal end was trapped at the tip of venous sheath which was successfully wired with percutaneous coronary angioplasty wire and retrieved with the help of 1.5×10mm and 2×10mm Maverick balloon (Boston scientific; USA). This is the first ever report of balloon assisted retrieval of intravascular foreign body.

CRT-200.06 Steerable Catheters For Intravascular Foreign Bodies: You Can Get There From Here

Intravascular foreign bodies (IVFB) are a well-described complication of endovascular procedures with significant morbidity and mortality. Retrieval of the IVFB is indicated if at all possible. Retrieval of IVFBs can be complex based on the location and cumbersome nature of the embolized device.

Five Cases of Neuroendovascular Treatment Using the Goose Neck Snare for Inducing and Holding the Guiding Catheter

The stabilization of a guiding catheter is a very important factor for successful endovascular treatment. However, it is sometimes difficult to obtain sufficient stabilization because of the tortuosity of the approach route. A Goose Neck Snare is useful for the retrieval of intravascular foreign bodies and can be used to hold the guiding catheter. We describe five cases of endovascular treatment performed while using the Goose Neck Snare via the brachial artery to hold the guiding catheter. We discuss the utility of this strategy.

Percutaneous retrieval of a fractured multipurpose catheter by an indigenous snare in a 25-year-old patient: a safe and feasible approach

Since the first report of percutaneous retrieval of intravascular foreign body in 1964, it has become a favourite approach for intravascular foreign body removal. Snares, biopsy forceps, dormia basket or tip deflecting wires are available options for this approach. Herein, we report percutaneous retrieval a fractured multipurpose catheter by an indigenous snare in a 25-year-old patient. The patient was a 25-year-old male being admitted with ostium secundum atrial septal defect and catheterization study was planned for shunt quantification. During manipulation to right ventricular outflow tract, multipurpose catheter got broken approx. 4 cm. proximal to tip. The broken part was captured through right femoral vein by a self-constructed snare. While removal, it broke at tip of venous sheath. Smaller one was retrieved and bigger was recaptured and finally retrieved by exaggerating the curve of same snare without any complications. Use of snares for intravascular foreign body removal is frequently reported and has been successful with low complication rates.

Isolated severe aortic stenosis in a tricuspid aortic valve in a 8-year-old boy

Since the first report of percutaneous retrieval of intravascular foreign body in 1964, it has been accepted as a favourite approach for intravascular foreign body removal. Snares, biopsy forceps, dormia basket or tip deflecting wires are available in the armamentarium for this approach. Herein, we report percutaneous retrieval of a dislodged J-tip guide-wire by self-constructed snare. A patient was a 75-year-old woman who was admitted with capture failure following post pacemaker implantation. J-tip guide-wire was inadvertently left in her inferior vena cava during temporary pacemaker insertion. The guide wire was approached through right subclavian vein by a self-constructed snare and it was removed without any complications. Use of snares for intravascular foreign body removal is frequently reported and has been successful with low complication rates; also, the low cost of such snares makes it safe and economical.

Endovascular foreign body retrieval

The number of endovascular procedures performed is increasing exponentially as technology improves. A serious complication of endovascular therapy is loss of a foreign body in the vasculature. We reviewed our experience and evaluated the cause, management, and outcomes of intravascular foreign body (IVFB) misplacement. We completed a retrospective review of patients who underwent endovascular retrieval of IVFBs between 2005 and 2010. Patients were identified by current procedural terminology code or by our hospital's risk management team. Patients undergoing routine endovascular retrieval of temporary vena cava filters were excluded. Twenty-seven IVFBs were identified in 26 patients. Twenty patients were asymptomatic (76.9%). Six patients were symptomatic (22.2%) with either pain (n = 4) or abnormal physical findings (n = 2). There were 13 (48.1%) catheter fragments, six (22.2%) guidewires, five (18.5%) inferior vena cava (IVC) filter (embolisms), two (7.4%) stents, and one (3.7%) sheath fragment. There were five (15.6%) embolizations of an IVFB into the right heart, three (9.4%) into a pulmonary artery, eight (25%) into the vena cava, eight (25%) into peripheral veins, five (15.6%) into peripheral arteries, one (3.1%) into a coronary artery, one (3.1%) into a hepatic vein, and one (3.1%) into adjacent soft tissue. The mechanism of endovascular loss was device fracture in 16 (59.3%) cases, loss of control in six cases (22.2%), migration in four (14.8%) cases, and incorrect device deployment in one case (3.7%). The probable cause of foreign body loss was technical error in eight (29.6%) cases. In three cases, IVFB retrieval was not attempted. The misplacement and retrieval were completed during the same procedure in 13 (48%) cases. Twenty-four endovascular retrievals were performed. Fifteen (62.5%) procedures used a snare to remove the IVFB and two (8.2%) used balloon catheters. Three IVFBs could not be removed and two cases were converted to open procedures. Technical success was achieved in 19/24 cases (79.2%). There were no immediate complications related to the retrieval of the IVFB; however, there was a single late complication of pulmonary embolism after failed endovascular retrieval (1/24, 4.2%). Thirty-day survival was 100%. Intravascular foreign bodies are a serious complication of endovascular therapy that can be minimized with proper device selection and deployment. When an intravascular foreign body is identified, endovascular retrieval should be attempted due to its high success rate and minimal morbidity.

Percutaneous Intraluminal Intravascular Retrieval of Foreign Body Under Ultrasound Guidance

Percutaneous retrieval of intravascular foreign body is a safe and effective procedure with the use of various imaging modalities. However, fluoroscopy is used extensively in most of the procedures, because the broken fragments which gets retained in intravascular compartments are radiopaque. In our case, the broken fragment, which was retained in the internal jugular vein, was radiolucent. Retrieval of a radiolucent foreign body under fluoroscopy is not only difficult but also can lead to serious sequelae during retrieval. We report such a case of real time ultrasound-guided retrieval of the foreign body in adjunct with fluoroscopy.

Percutaneous Retrieval of an Intravascular Catheter Embolus

진행성 위암 ìˆ˜ìˆ í›„ 항암 치료를 위해 우쇄골하 ì •ë§¥ì„ 통한 ì¤‘ì‹¬ì •ë§¥ ì‚½ìž í›„ ì¹´í Œí„° 도관의 위치 이상과 기능 이상으로 ì¹´í Œí„° 도관을 교체하는 ê³¼ì •ì—ì„œ ì¹´í Œí„° ë¶„ì ˆì˜ 일부가 ë–¨ì–´ì ¸ë‚˜ê°€ 좌 폐엽동맥에 위치해 있어 이를 loop snare를 이용한 ê²½í”¼ì  혈관 ì¤‘ìž¬ìˆ ì„ 통해 합병증 없이 ì„±ê³µì ìœ¼ë¡œ ì œê±°í•œ 1예를 경험하였기에 ë³´ê³ í•˜ëŠ” 바이다. 중심 단어: 쇄골하 ì •ë§¥ 도관; ì¹´í Œí„° ë¶„ì ˆ ìƒ‰ì „ì¦; Loop snare

Percutaneous retrieval of intravascular venous foreign bodies in children

The use of vascular lines both venous and arterial in children has significantly increased in the last decade with the potential risk that an intravascular device may become an intravascular foreign body. Percutaneous retrieval by interventional radiology has become an accepted method of foreign body removal. The objective of this study is to describe a single center's experience of percutaneous intravascular foreign body removal in pediatric patients. Between January 2000 and December 2008, 18 patients underwent percutaneous intravascular foreign body retrieval as a complication of venous access devices. The mean catheter days were 181.2 catheter days (1 to 1,146 days). A retrospective review was performed and demographic data and clinical information were recorded, including type, duration, location of access device, embolization location and retrieval technique. Eighteen of 19 (94.7%) retrievals were performed with single-loop snares and 1/19 (5.3%) was a triple-loop snare. Seventeen of 19 (89.5%) retrievals were successful. One unsuccessful retrieval was successfully removed by surgery, while the other was retained. Percutaneous intravascular foreign body retrieval by interventional radiologists is a safe and effective method of retrieving embolized fragments from venous access devices in pediatric patients.

Placement and Removal of Inferior Vena Cava Filters: National Trends in the Medicare Population

The aim of this study was to evaluate trends in the placement and removal of inferior vena cava (IVC) filters in the Medicare population. Summary Medicare claims data from 1999 through 2008 were used to identify the frequency of IVC filter placement procedures by specialty (radiology, surgery, cardiology, and all others) and site of service. Claims from 2003 (the first year the FDA cleared retrievable labeling for filters) through 2008 were used to identify intravascular foreign body retrieval procedures, and modeling was used estimate a frequency range of removal procedures. Trends over time were evaluated. Between 1999 and 2008, total Medicare fee-for-service beneficiary frequency of IVC filter placement procedures increased by 111.5% (30,756 to 65,041). Volumes increased for radiologists (16,531 to 36,829 [+122.8%]), surgeons (11,295 to 22,606 [+100.1%]), and cardiologists (1,025 to 4,236 [+313.3%]). Relative specialty market shares changed little over time. Volumes increased by 114.2% (26,511 to 56,774) and 229.1% (2,286 to 7,524) for hospital inpatients and outpatients, respectively, and decreased by 62.1% (1,959 to 743) for those in all other locations combined. In 2008, with 65,041 filters placed, only an estimated 801 to 3,339 (1.2 to 5.1%) were removed. The frequency of IVC filter placement has doubled over the past decade, and radiologists continue to perform more than half of all procedures. Although volume has more than tripled in hospital outpatients, the inpatient setting remains by far the most common site of service. In the Medicare population, IVC filters are not commonly removed.

Táticas e técnicas endovasculares para retirada de corpos estranhos intravenosos

The incidence of intravascular embolization of venous catheters reported in the world medical literature corresponds to 1% of all the described complications. However, its mortality rate may vary between 24 to 60%. Catheter malfunction is the most likely signal of embolization, since patients are usually asymptomatic. To report the method of removing intravascular foreign bodies, catheters with the use of various endovascular techniques and procedures. This is a two-year retrospective study of 12 patients: seven women and five men. The average age was 29 years (ranging from two months to 65 years). Technical performance was 100% successful. Ten port-a-caths, one intra-cath and one PICC were extracted. The most common sites for the lodging of one of the ends of the intravascular foreign bodies were the right atrium (41.6%) and the right ventricle (33.3%). In 100% of the cases, only one venous access was used for extraction of foreign bodies, and in 91.6% of the cases (11 catheters) the femoral access was used. The loop-snare was used in 10 cases (83.3%). The most common cause of intravascular foreign body insertion was a catheter fracture, which occurred in 66.6% of the cases (eight cases). One major complication, the atrial fibrillation, occurred (8.3%), which was related to the intravascular foreign body extraction. The mortality rate in 30 days was zero. Percutaneous retrieval of intravascular foreign bodies is considered gold standard treatment because it is a minimally invasive, relatively simple, safe procedure, with low complication rates compared to conventional surgical treatment.

Intravascular foreign bodies: danger of unretrieved fragmented medical devices

A warning on the danger of unretrieved device fragments and recommendations to mitigate the danger were issued by the Food and Drug Administration in January 2008. The causes of intravascular foreign bodies are classified into three main categories: improper manipulation and usage, device defects, and others, such as patient and anatomical factors. Device failure after long-term use is rarely predicted at the time of approval, since device abnormality is rarely experienced in animal studies and clinical trials conducted during development of the device. Stent fracture due to metal fatigue is one example. Complex complications could occur from simultaneous use of two or more devices with diverse characteristics. The success rate of percutaneous retrieval of intravascular foreign bodies has improved with the advances in commercially available devices. However, the procedure is not always successful and sometimes surgical removal becomes necessary. Appropriate device selection and acquisition of experience in using the device are important. When an intravascular foreign body cannot be retrieved, the risk of complication could be high. Magnetic resonance imaging examination sometimes causes adverse events, including burns due to the heat generated by metal movement. Such information should be correctly recorded. Furthermore, it is necessary to provide patients with adequate information about the characteristics of implanted devices and unretrieved fragments. We reviewed the literature on unretrieved medical device fragments and include articles that describe the Japanese experience.

Ventriculoperitoneal shunt migration into the pulmonary artery

Ventriculoperitoneal (VP) shunting is the most common form of treatment for hydrocephalus. Complications of VP shunts may occur anywhere along their course from the cerebral ventricle to the peritoneal cavity. Rare complications such as migration of the peritoneal catheter into the stomach, gallbladder, urinary bladder, vagina, liver, bowel, colon, and diaphragm have been described in the literature. In this review of the literature we discuss the rare but serious event of migration of the distal catheter of a ventriculoperitoneal shunt (VP shunt) into the pulmonary artery. We present an additional patient with a special emphasis on minimally invasive treatment. The patient's postoperative course was uneventful, and a postoperative plain X-ray of the chest and abdomen confirmed appropriate placement of the new distal catheter intraperitoneally. It is useful to consider alternative nonsurgical techniques for percutaneous intravascular foreign body retrieval. Many different percutaneous techniques have been described. Rare complications of percutaneous intravascular foreign body retrieval may include transient cardiac arrhythmia, fragmentation of the foreign body, or migration of the foreign body to a different location. A multidisciplinary discussion and approach is pivotal to treating this extraordinarily rare complication.

Removal of a temporary pacemaker lead fragment with the use of biopsy forceps

The percutaneous retrieval of intravascular foreign bodies is a rather frequently applied technique, given the growing number of vascular procedures in daily clinical practice. Various types of devices have been used, such as gooseneck snares, Dormia baskets, tip deflectable wires, or biopsy forceps. A 75-year-old male was admitted to the Coronary …