Vascular Foreign Bodies Research Articles

Retrieval of a Broken Umbilical Artery Catheter in a Neonate

Background Umbilical arterial catheterization is an extremely useful tool in the premature, sick neonate for intensive monitoring and as a source of arterial blood sampling. We describe the case of an inadvertent breakage of an umbilical artery catheter (UAC), to replace it, and the potential complications that can arise. Case Report A premature 33-week infant weighing 1.965 kg was admitted to the neonatal intensive care unit (NICU) and had umbilical catheterization. An abdominal X-ray (AXR) was done following the procedure to confirm the position, and the UAC was found to be too low, between T11 and T12. In attempting to replace it, the UAC was transected, with the umbilical stump bleeding, and the internal tip not seen. The patient underwent laparotomy and examination under anesthesia revealed a UAC that was palpable in the right lower quadrant and fluoroscopy revealed a tip in the external iliac artery. This migrated with each subsequent palpation. Meticulous dissection revealed a catheter which was palpable in the right internal iliac artery. The bifurcation was cleared, and vascular slings applied, getting proximal and distal control. The vessel was opened, and the catheter retrieved in its 15-cm entirety. The vessel was repaired with 7/0 Prolene suture. Conclusions This case is intended to highlight that even a trivial procedure of UAC removal must be done carefully with appropriate instrumentation to prevent this complication. For retrieval of this type of vascular foreign body, an open technique can be used with the assistance of fluoroscopy. Endovascular retrieval techniques are also an option but are not available in our setting for this age group.

Iatrogenic complications: a line's share

Encountering foreign bodies in clinical practice is not uncommon. More so are intra-vascular foreign bodies. Foreign bodies encountered vary in different scenarios depending on the person; children, elderly or mentally retarded or the cause; iatrogenic as in our case. In clinical practice vascular foreign bodies are the most commonly encountered iatrogenic foreign bodies. Fracture of intravenous catheter is one of those iatrogenic vascular foreign bodies. Here we describe a case report on a vascular foreign body due to fracture of intravenous cannula in the cephalic vein and which has migrated proximally.

Rothia bacteremia: a 10-year experience at Mayo Clinic, Rochester, Minnesota.

Rothia spp. are Gram-positive cocco-bacilli that cause a wide range of serious infections, especially in immunocompromised hosts. Risk factors for Rothia mucilaginosa (previously known as Stomatococcus mucilaginosus) bacteremia include prolonged and profound neutropenia, malignancy, and an indwelling vascular foreign body. Here, we describe 67 adults at the Mayo Clinic in Rochester, MN, from 2002 to 2012 with blood cultures positive for Rothia. Twenty-five of these patients had multiple positive blood cultures, indicating true clinical infection. Among these, 88% (22/25) were neutropenic, and 76% (19/25) had leukemia. Common sources of bacteremia were presumed gut translocation, mucositis, and catheter-related infection. One patient died with Rothia infection. Neutropenic patients were less likely to have a single positive blood culture than were nonneutropenic patients. Antimicrobial susceptibility testing was performed on 21% of the isolates. All of the tested isolates were susceptible to vancomycin and most beta-lactams; however, four of six tested isolates were resistant to oxacillin. There was no difference between the neutropenic and nonneutropenic patients in need of intensive care unit care, mortality, or attributable mortality.

Vascular and Interventional Radiology

PART I: General Principles. Evaluation and Care of the Interventional Patient. Pharmacology. Vascular Biology and Physiology. Imaging Techniques. Access Techniques. Vascular Recanalization Technique. Vascular Occlusion Techniques. PART II: Vascular Diagnosis and Intervention. Thoracic Aorta. Abdominal Aorta. Upper Extremity Arteries and Veins. Lower Extremity Arteries. Mesenteric Arteries. Abdominal Arteries. GI Hemorrhage. Portal Venous System. Renal Arteries and Veins. Endocrine System. Pulmonary and Bronchial Arteries. Inferior and Superior Vena Cava. Lower Extremity Veins. Hemoodialysis Grafts. Varicocele Embolization. Vascular Access Placement. Vascular Foreign Body Retrieval. Vascular Complications of Transplantation. Lymphatic System. PART III: Non-Vascular Interventon. Percutaneous Biopsy. Percutaneous Fluid Drainage. Gastrointestinal Interventions. Transplant Complications. Biliary Interventions. GU Interventions. Pancreatic Interventions. Fallopian Tube Recanalization.

Retrieval of vascular foreign bodies using a self-made wire snare

Foreign bodies in the vascular system have a high potential to cause embolization, perforation, and infection. Therefore, numerous commercially available percutaneous retrieval devices have been developed. To evaluate the feasibility and efficacy of a self-made wire snare for the retrieval of foreign bodies in the vascular system. 16 consecutive patients, who underwent percutaneous foreign-body retrieval between 1997 and 2007, were included in this retrospective analysis. Percutaneous extraction was performed using an adjustable wire snare that was fabricated using a 5F diagnostic Headhunter or Multipurpose catheter and a 4-m-long 0.018-g/inch standard heavy-duty wire that was bent in the middle to create an eccentric loop. Percutaneous foreign-body retrieval was successful in all 16 cases. Intraluminal materials including partially fractured venous catheters, guidewires, a stent, and a vena cava filter were removed from various locations. In six cases, mobilization of the intraluminal material via a pigtail catheter was necessary before using the wire snare for removal. Successful retrieval was investigator independent. In no cases were surgical procedures required, and no relevant complications were encountered. This snare technique is an effective, feasible, and cost-effective method to retrieve intraluminal material. It is an alternative to commercially available retrieval devices.

Percutaneous vascular foreign body retrieval: Experience of an 11-year period

Over an 11-year period, percutaneous retrieval of intravascular foreign bodies was performed in 12 patients, using urological forceps and retrieval baskets. No clinically significant complication occurred, success rate was 100%. Review of 176 cases from the literature showed a success rate of 90%.

Septicemia I. A prospective study on etiology, underlying factors and sources of infection.

In a prospective study, 110 cases of proved and 41 of probable septicemia were analysed. Underlying diseases or factors were common, also in young patients, often narcotic drug or alcohol abusers. In one third, septicemia was probably hospital-acquired. Streptococci, staphylococci and gram-negative enteric rods were most common, followed by pneumococci and haemophilus species. Staphylococci and gram-negative enteric rods dominated in patients hospitalized at or before the onset of disease, and staphylococci in patients with vascular foreign bodies and in drug addicts. Enteric rods were common in elderly patients with urogenital disease, especially after instrumentation. Among streptococci, alpha-streptococci dominated; they did not emanate as often from dental foci as expected. In 2 of 3 asplenic patients with extensive hemorrhages pneumococci were found. Bacteria of low virulence and fungi occurring as opportunists were rare. Mixed infections, present in 4 cases, were severe. Portals of entry could often be proved or assumed. In half of all patients, the same organism was isolated from a primary focus as from blood. The importance of underlying illnesses and factors and of invasive procedures was evident. A tentative etiological diagnosis could often be made, based on case history, underlying factors and the probable portal of entry.

Therapeutic Angiography

Standard angiographic techniques formerly used exclusively as diagnostic modalities have been modified to serve as definitive or adjunctive therapeutic measured. The techniques include transcatheter embolization; infusion of vasoactive drugs, chemotherapeutic agents and radioactive particles; tamponade of bleeding arteries and balloon catheters; extraction of vascular foreign bodies and retained biliary tract stones and transluminal arterial dilation. These techniques have been proved effective and safe when used judiciously.