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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
Results
Percutaneous retrieval of the intravascular foreign bodies was successful in all 6 patients (100%) in the first attempt.
Cases included 3 OptEase IVC filters and 3 misplaced guide wires introduced for central venous access.
Mean duration of IVC filter placement was 4 weeks.
Misplaced guide wires were recovered within 24 hours of recognition.
Additional devices for retrieval were not required in any case.
No major or minor procedure related complications were encountered.
Type of foreign body |
IVC filters n=3,
Guidewires n=3 |
Mean duration of filter placement |
4 weeks |
Timeline for guidewire retrieval |
Within 24 hours |
Use of additional devices |
Not required |
Complications |
None |
Fig. 2: 47-year-old male with misplaced guide wire lost during central venous access procedure. Guide wire seen coiled in superior vena cava.
Fig. 3: Loop of self made wire snare advanced just beyond the end of coiled foreign body
Fig. 4: Ensnared guide wire
Fig. 5: Ensnared guide wire now slides downwards through inferior vena cava for removal via right femoral access site
The rapid development of new endovascular materials and devices requires a constant adaptation and refinement of retrieval techniques.
Moreover,
retained intravascular foreign bodies are a potential source of complications.
Caval thrombosis has a reported rate of up to 5 % (6).
Guide wires and vena cava filters may perforate the vascular wall (7).
For these types of foreign objects,
there is a clear and urgent indication for percutaneous removal (1).
The rate of broken venous catheters has been estimated at 0.1% (8),
but limited data are available for other types of objects,
such as broken guide wires or lost embolization coils.
First reported case of self made wire snares used for removal of broken guidewire fragments foreign body retrieval dates back to 1969 (9).
Later,
Zollikofer et al.
reported successful percutaneous catheter retrieval in 4 patients (10).
Newer retrieval tools have now simplified and accelerated procedures for foreign body removal.
Commercially available wire snares have proved to be easy and safe in usage with low complication rates.
These however have the disadvantage of being costly.
There is limited data to support the routine use of homemade wire snares in current practice.
Mallmann et al.(3) has reported 100% success using this type of device in 16 cases.
Similar technique was employed by Kuldeep Singh et al.
(5) for retrieval of vena caval filters in 14 patients.
Apart from being inexpensive this type of snare has a variable size loop which is adjustable.
The end of the loop can be gently curved and the snare so formed can be deflected either way.
Moreover,
the angiographic catheters used commonly (mostly an H1 or C2) have a shaped tip which helps achieve a better translational torque than commercial snares.
Reported disadvantages include repeated opening of snare assembly parallel to the IFB,
requiring multiple attempts to ensnare the IFB and thus time consuming (6).
Limitations of our data include small sample size (n=6) which may underestimate the effectiveness of this technique.
Moreover,
all retrievals were performed by the same interventional radiologist so variability in operator expertise could not be assessed.