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Keywords:
Foreign bodies, Technical aspects, Removal, Cost-effectiveness, Catheter venography, Catheter arteriography, Veins / Vena cava, Vascular, Interventional vascular
Authors:
M. Jehangir, A. Rana, E. M. Kiani; Islamabad/PK
DOI:
10.1594/ecr2015/C-1536
Methods and materials
Study was approved from institutional review board.
In a 3 year period,
from April 2011 to February 2014,
6 consecutive patients underwent endovascular foreign body retrieval.
Data of all cases was retrospectively acquired using the radiology reporting database.
All six patients were males.
Age range was from 23 to 77 years (mean 48 years).
Indication for retrieval included 3 misplaced guide wires lost during central venous access procedures.
Others were 3 temporary OptEase inferior vena cava filters which were placed in patients with DVT secondary to immobilization after lower limb fractures.
A successful procedure was defined as complete removal of intravascular foreign body without post-procedural complications.
All retrievals were performed in the Interventional Radiology suite under local anesthesia by an interventional radiologist having more than 10 years experience in vascular interventional radiology.
For vascular access a femoral approach was used in all 6 cases.
An 8 Fr guide catheter was cut to appropriate size length if required.
It was introduced through a short sheath.
Prior to vascular access,
the size and position of the foreign body was evaluated under fluoroscopy to check whether the material was entrapped at both ends.
A pigtail catheter was used in one patient to mobilize the entrapped fragment to provide free access for the snare.
A Headhunter or Multipurpose catheter (5Fr) was used.
The self-made wire snare was then fabricated using a 300 cm,
0.014" wire which was bent in the middle and advanced through a 5 Fr C2 catheter to make a loop.
It was difficult to advance this bent wire through the 5 Fr catheter and the wire was passed into the catheter from the tip in a backward fashion.
Its tip was positioned just beyond the tip of the catheter.
This assembly was then advanced through the guide catheter.
Once at the end of misplaced guide wire to be retrieved or the IVC filter,
the bend wire snare was advanced.
A loop was then made by pulling one limb of the wire which made a C shaped loop.
This was then used to snare the end of the foreign body.
The 5 Fr catheter was advanced to close the snare and fix the foreign body in the wire snare.
In one case when using left groin approach for an IVC filter it was difficult to snare the hook of the filter and a bend (about 30 degrees) was made in the wire limbs about 5 cm from the tip.
The hook was then easily snared in this patient.
The guiding catheter was then advanced over the IVC filters or the wire foreign bodies were pulled in to the guide catheter.
The catheter was then removed successfully removing the foreign body. Fig. 1: Assembly of home made wire snare