|Year : 2018 | Volume
| Issue : 4 | Page : 484-485
Intravascular Foreign Bodies: A Single-Institution Experience and Description of a Novel Modified Percutaneous Retrieval Technique
Mario Enrique Baltazares-Lipp1, Benito Sarabia-Ortega1, Juan Ignacio Soto-González1, Carlos Manuel Aboitiz-Rivera2, Héctor A Carmona-Ruiz1, Ruben Blachman-Braun3
1 Department of Hemodynamics and Echocardiography, National Institute of Respiratory Diseases “Ismael Cosío Villegas”, 14080 Mexico City, Mexico
2 Department of Hemodynamics and Echocardiography, National Institute of Respiratory Diseases “Ismael Cosío Villegas”, 14080 Mexico City; Centro de Investigación en Ciencias de la Salud, Facultad de Ciencias de la Salud, Universidad Anáhuac México Campus Norte, Estado de México 52786, México
3 Centro de Investigación en Ciencias de la Salud, Facultad de Ciencias de la Salud, Universidad Anáhuac México Campus Norte, Estado de México 52786, México
|Date of Submission||04-Nov-2017|
|Date of Web Publication||09-Feb-2018|
Dr. Ruben Blachman-Braun
Centro de Investigación en Ciencias de la Salud, Facultad de Ciencias de la Salud, Universidad Anáhuac México Campus Norte, Av. Universidad Anáhuac No 46, Colonia Lomas Anáhuac, Huixquilucan, Estado de México, CP 52786
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Baltazares-Lipp ME, Sarabia-Ortega B, Soto-González JI, Aboitiz-Rivera CM, Carmona-Ruiz HA, Blachman-Braun R. Intravascular Foreign Bodies: A Single-Institution Experience and Description of a Novel Modified Percutaneous Retrieval Technique. Chin Med J 2018;131:484-5
|How to cite this URL:|
Baltazares-Lipp ME, Sarabia-Ortega B, Soto-González JI, Aboitiz-Rivera CM, Carmona-Ruiz HA, Blachman-Braun R. Intravascular Foreign Bodies: A Single-Institution Experience and Description of a Novel Modified Percutaneous Retrieval Technique. Chin Med J [serial online] 2018 [cited 2018 May 25];131:484-5. Available from: http://www.cmj.org/text.asp?2018/131/4/484/225060
To the Editor: Catheters are frequently used as diagnostic and therapeutic devices that are frequently placed in critically ill patients. In addition, with the advantage of radiologic technology, the number of minimally invasive endovascular procedures has increased, and consequently the reports of intravascular foreign bodies (IFBs), and the numerous described IFBs retrieval technique. Despite the importance of the subject, there is a lack in the reports of iatrogenic IFBs in Mexico; therefore, we report our experience in the management of adult patients with this complication and described a new IFBs removal technique.
Overall, 13 patients underwent percutaneous IFBs retrieval at our institution from 1999 to 2016. Eight were females; twelve had free intravascular catheters located within the right venous system, right atrium (RA), right ventricle (RV), or pulmonary artery (PA); one case had a metal guide located in the left ventricle and aortic arch. The extracted IFBs include five central catheters, two vascular catheters port, three catheter tip, one Swan-Ganz catheter, and two metal guidewires (one located in LV and aortic root) [Figure 1]a.
|Figure 1: (a) Guidewire into the left ventricle and aortic root, (b) remove the steel core from the Teflon guidewire, (c) insert the Teflon guide into the Judkins guide, (d) introduce the Teflon guidewire until a gooseneck-like is created.|
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The technique used for the IFB removal was chosen according to the location and object characteristics. Patients with catheters located within the right venous system, RA, RV, or PA underwent right heart catheterization, utilizing Günther Tulip Vena Cava MReye Filter and Retrieval set of COOK Instrument, which utilizes a metal gooseneck handle for the removal. For the patient with a guidewire housed in the left ventricle and aortic arch, due to the limited institutional resources, we had the need to innovate, taking into account the classic GooseNeck Snare catheter technique,,, we create a gooseneck-like recovery technique, which consists of the following steps: (1) left catheterization; (2) the steel core of the Argon Teflon guide 0.032 was removed [Figure 1]b, and then the Teflon guide was placed within the straight Judkins guiding catheter 6 Fr to create a gooseneck-like catheter [Figure 1]c and [Figure 1]d; and (3) the Teflon gooseneck-like catheter was maneuvered until the wire end was held and the IFB was recovery.
For the patient who underwent the Gooseneck Snare-like catheter recovery technique with a Teflon guide without steel core, extraction was achieved without arrhythmias or complications. During all the procedures, the guidewire was frequently injected with unfractionated heparin solution to prevent thrombus formation.
Overall, 11 IFBs were removed without complications, and in two cases, extraction was not achieved. In thefirst unsuccessful case, the catheter fractured a year earlier and was adhered to the endothelium, the lower distal branch of the right PA. The second unsuccessful case was an IFB located in the left main PA branch, which upon manipulation migrated to the interlobar artery.
IFBs are commonly the result of a poor placement technique, incorrect catheter use, or long period exposure. In addition, it is clinically important to consider that IBFs have a wide range of complications from asymptomatic cases to patients with phlebitis, pain, arrhythmias, cardiac perforation, thrombosis, endocarditis, IFB migration throw the venous system, pulmonary embolization, or even death. Thus, when the clinical status of the patients allows, IFBs should be recovered within 24 h after diagnosis is made, to decrease the risk of complications.
In conclusion, in the majority of the patients, the metal handle in gooseneck and basket is an advantageous method for IFBs removal. However, the newly described technique that uses the Teflon guidewire to creating a gooseneck-like catheter should be considered another option for IFB removal when institutional resources are limited.
The authors appreciate the support of the Instituto Nacional de Enfermedades Respiratorias “Ismael Cosío Villegas.”
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Romeo P, Calvagna GM, Giunta M, Vitale FV, Patanè S. Removal of an intracardiac lost port-A catheter utilizing a simple low-cost method. Int J Cardiol 2014;176:1309-11. doi: 10.1016/j.ijcard.2014.07.156.
Schechter MA, O'Brien PJ, Cox MW. Retrieval of iatrogenic intravascular foreign bodies. J Vasc Surg 2013;57:276-81. doi: 10.1016/j.jvs.2012.09.002.
Floridi C, Nocchi-Cardim L, De Chiara M, Ierardi AM, Carrafiello G. Intravascular foreign bodies: What the radiologist needs to know. Semin Ultrasound CT MR 2015;36:73-9. doi: 10.1053/j.sult.2014.11.001.
Sheth R, Someshwar V, Warawdekar G. Percutaneous retrieval of misplaced intravascular foreign objects with the Dormia basket: An effective solution. Cardiovasc Intervent Radiol 2007;30:48-53. doi: 10.1007/s00270-005-0297-4.
Yedlicka JW Jr., Carlson JE, Hunter DW, Castañeda-Zúñiga WR, Amplatz K. Nitinol gooseneck snare for removal of foreign bodies: Experimental study and clinical evaluation. Radiology 1991;178:691-3. doi: 10.1148/radiology.178.3.1994404.