Percutaneous retrieval of intravascular venous foreign bodies in children

Successful retrieval of a foreign body in an infant's right pulmonary artery using the new boomerang loop-snare technique: A case report

We report successful percutaneous retrieval of a foreign body located in an infant's right pulmonary artery using the new boomerang loop-snare technique. The case was an 18-month-old girl. A central venous catheter for chemotherapy was inserted from the right subclavian vein during treatment for myelodysplastic syndrome at another hospital. A postprocedural chest X-ray showed a foreign body in her right lung, and contrast-enhanced computed tomography confirmed the linear foreign body was located in the right pulmonary artery. The patient was transferred to our hospital to retrieve the foreign body. Under cooperation with pediatric cardiologists, a 6 Fr sheath was inserted via the right femoral vein, and a guiding catheter was advanced into the right pulmonary artery. Owing to the risk of vascular injury when using endoscopic forceps, we decided to use the loop-snare technique. We successfully crossed over the foreign body using a steerable microcatheter and a long microguidewire. The microguidewire was reinserted into the guiding catheter, and a loop was created by grasping the end of the wire using a microsnare catheter, which was inserted coaxially within the guiding catheter. By pulling the microsnare catheter, we were able to pull the foreign body into the guiding catheter and successfully retrieved it. There were no complications, such as pulmonary artery injuries or thrombi. The recovered foreign body was a piece of a guidewire. The boomerang loop-snare technique using a small-diameter system is useful for the retrieval of a foreign body in infants.

Pulmonary embolism and hemorrhage after displacement of angiographic catheter tip to pulmonary artery: A case report and literature review

Pulmonary embolism and massive hemoptysis caused by intravascular foreign bodies have rarely been reported. We report a case of an end-stage renal disease patient in which the tip of the angiographic catheter fell off into the pulmonary artery during endovascular interventional opening when the patient underwent vascular access occlusion for dialysis. During the operation, the foreign body was displaced repeatedly and finally anchored to the posterior basal segment branch of the right lower pulmonary artery. A pulmonary embolism occurred during the operation, and massive hemoptysis and hemorrhagic shock occurred after anticoagulation and thrombolytic therapy. After receiving anti-shock and symptomatic treatment, the patient gradually recovered. After six months of follow-up, no pulmonary embolism or pulmonary infarction occurred. Our case report presents an alternative approach to extracting a foreign object from the pulmonary artery by locating the foreign object within the vascular terminations, without resorting to forceful removal. This method mitigates the potential risks of pulmonary embolism and bleeding associated with forceful extraction.

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

BACKGROUND

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.

PATIENTS AND METHODS

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.

RESULTS

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).

CONCLUSION

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.

Percutaneous snare-retrieval of intracardiac thrombus under fluoroscopic and transesophageal echocardiography guidance: case report and systematic review

Intracardiac foreign bodies (IFB) are rare clinical conditions. There are now several reports on the percutaneous retrieval of IFB under fluoroscopy. However, some IFB are not radiopaque, and retrieval requires combined fluoroscopic and ultrasound guidance. We report the case of a bedridden 23-year-old male patient with T-lymphoblastic lymphoma treated with long-term chemotherapy. Ultrasound examination diagnosed a huge thrombus in the right atrium near the opening of the inferior vena cava which affected the patency of his PICC line. Ten days of anticoagulant therapy did not modify the thrombus size. Open heart surgery was not feasible because of the patient clinical condition. Snare-capture of the non-opaque thrombus was done from the femoral vein under fluoroscopic and ultrasound guidance with excellent outcomes. We also present a systematic review of IFB. We found out that percutaneous removal of IFBs is a safe and effective procedure. The youngest patient who received percutaneous IFB retrieval was 10 days old and weighed only 800 g, while the oldest patient was 70 years old. Port catheters (43.5%) and PICC lines (42.3%) were the most commonly found IFBs. Snare catheters and forceps were the most commonly used instruments.

Endovascular removal of intravascular foreign bodies: A single-center experience and literature review

OBJECTIVE

To describe causes, clinical signs, experience and endovascular techniques for extraction of intravenous foreign bodies (IFB) and literature review.

METHODS

This retrospective study was based on data collected from the medical records of 51 consecutive patients (26 women and 25 men) treated from July 2007 to May 2020 at a single quaternary center in Brazil and case series with data, published in the literature since 2000 on IFB removal, of at least five patients. The average patient age was 43.54 years (range, 2 months to 84 years). The different retrieval method using the following was used in the procedure: gooseneck snare, guidewire, balloon, and custom snares.

RESULTS

The retrieval process rate was 100%. Thirty-one port-a-caths, six guidewires, four double lumens, three permcaths, three Shiley® catheters, one intra cath, two peripherally inserted central catheters, and one stent were extracted. The locations where the IFBs were most frequently trapped were the right atrium (39.2%), the pulmonary artery (17.64%), the superior vena cava (13.72%), and the right ventricle (16.12%). Single venous access was used in 67.07% of the patients. Femoral access, which was the most commonly used approach, was used in 85.71% of the patients. The loop was used in 64.70% of the patients. A fractured catheter was the main IFB in 60.76% of the cases (31 patients). Only one complication related to the extraction of an IFB was noted in a single patient who suffered from atrial fibrillation (1.96%). The 30-day mortality rate was zero.

CONCLUSION

Percutaneous IFB removal should be considered as an alternative for the treatment and retrieval of IFBs because it is a minimally invasive procedure that is relatively simple, safe, and has low complication rates.

Iatrogenic vascular trauma and complications of vascular access in children

Vascular access is frequently a critical component of the diagnostic and therapeutic procedures required to manage childhood illnesses, including many emergent conditions and critical illnesses. Vascular access in the pediatric population presents unique challenges, and many clinical and technical factors must be considered to avoid complications that can occur with vascular access procedures. This article reviews various aspects of vascular access and associated iatrogenic trauma in children, including risk factors, management of complications, and preventive measures to avoid complications. It is only with a comprehensive understanding of the topic that vascular access in children can be performed safely, effectively, and efficiently.

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

BACKGROUND

Percutaneous retrieval of intravascular foreign bodies has recently increased as a treatment option.

PURPOSE

To report our single-center experience of the percutaneous retrieval of 14 intravascular embolized catheter fragments in children and to conduct a literature review.

MATERIAL AND METHODS

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.

RESULTS

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).

CONCLUSION

Percutaneous retrieval of intravascular foreign bodies is a feasible, safe, and efficient technique in children and should be considered the preferred treatment option.

Recovery of a broken PICC migrated in cardiac chambersan endovascular approach

Complications related to the placement of a peripherally inserted central catheter are a common phenomenon and they can lead to acute complications which must be treated in an emergency regime. The aim of this study was to describe cases in their most practical and technical aspect, especially in complicated conditions.

This was a descriptive case report of a 64 years old female patient who presented with a fractured peripherally inserted central catheter, migrated into the right heart chambers and inferior vena cava, and how the team arranged for its recovery by endovascular technique, in a frail patient who could not undergo to open surgery.The procedure was completed without any complications. The use of the endovascular technique allows a recovery of the foreign body in a short time, essential for a life-saving procedure; the interventional radiological approach allows less invasiveness in fragile patients and shorter hospitalization times.

Diagnostic error in detection of fractured and migrated totally implantable venous access device fragments and experience with percutaneous retrieval: A report of 27 cases

PURPOSE

To assess diagnostic efficacy/error to identify broken or dislocated totally implantable venous access device (TIVAD) fragments on radiological studies and to analyze interventional outcome of percutaneous retrieval.

MATERIALS AND METHODS

Retrospective, single-center analysis of 27 patients, referred for percutaneous retrieval of embolized TIVAD fragments between 2000 and 2018. Demographic data, underlying disease, diagnostic studies, diagnostic error, interval between implantation and diagnosis of TIVAD-dysfunction, interval between diagnosis and retrieval, anatomical location of the embolized fragments, and technical aspects of retrieval procedure were identified from the patients' electronic medical records.

RESULTS

Overall, diagnostic error was found in six patients (22%) with an average delay of 53 days. Ten fractures were caused during surgical removal, eleven fractures by pinching between first rib and clavicle and six cases by spontaneous disconnection between reservoir and catheter. Success rate of retrieval was 96% and the complication rate 0%.

CONCLUSION

Fractured or retained TIVAD fragments were initially overlooked on radiological studies in more than 20% of patients. Percutaneous retrieval of broken and dislocated TIVAD fragments is very safe and highly successful.

Retrieval of Intravascular Fractured Fragment of Tunnelled Double Lumen Catheter in Hemodialysis Patient

BACKGROUND:

Intravascular fractured fragment of double lumen catheter with embolisation is a serious and rare complication. Another serious complication includes infection, thrombosis, arrhythmias, and pulmonary embolism. We report a successful surgical venous cut-down technique in the retrieval of an intravascular fractured fragment of tunnelled double lumen catheter in a hemodialysis patient.

CASE REPORT:

A 51-year-old female underwent hemodialysis through a tunnelled double lumen catheter and had her arterio-venous graft matured. During retrieval of tunnelled double lumen catheter procedure, the distal part of the catheter was fractured and slipped into the internal jugular vein. Chest radiograph revealed intravascular double lumen catheter extending from the distal part of the right internal jugular vein to right atrium. The procedure of foreign body retrieval was done the next day under general anaesthesia and C-Arm guidance using right internal jugular venous cut-down approach. A right-angle clamp was used to retrieve the fragment without any post-procedure complications.

CONCLUSION:

Intravascular fractured fragment of double lumen catheter is a dangerous situation as are all the intravascular foreign bodies. The choices of the technique for retrieval of the fractured fragment are varied. It depends on the type and site of a fractured fragment as well as the surgeon experiences.

Transcatheter Retrieval of Cardiovascular Foreign Bodies in Children: A 15-Year Single Centre Experience

There has been a rapid increase in the practice of interventional catheter treatment of congenital heart disease. Catheter retrieval of embolized cardiac devices and other foreign bodies is essential, yet no large studies have been reported in the paediatric population. Retrospective 15-year review of all children who underwent transcatheter foreign body retrieval in a tertiary cardiac centre from January 1997 to September 2012. Transcatheter retrieval of foreign bodies from the cardiovascular system was attempted in 78 patients [median age 4 (0.02-16) years and median weight 15 (1.7-74) kg] including 46 embolized devices. Transcatheter retrieval was successful in 70/78 (90%), surgical retrieval was required in 6. In two patients, small embolized coils were left in situ. Gooseneck snare was the most commonly used retrieval device. Median procedure and screening times were 90 (15-316) and 31 (2-161) min, respectively. There were no procedural deaths. Transient loss of foot pulses occurred in 5 and 2 patients required blood transfusion. Transcatheter retrieval of cardiovascular foreign bodies can be performed safely in the majority of children thus obviating the need for surgery. It is essential to have a comprehensive inventory of retrieval equipment and interventional staff conversant with its use.

Removal of a retained intracardiac radiolucent guidewire fragment using an Atrieve™ vascular snare using combined fluoroscopy and transesophageal echocardiography guidance in an infant

Retained intravascular foreign body is a well-known complication of central venous access placement in children as well as adults. Most of these foreign bodies are radio-opaque and hence are removed under fluoroscopy guidance. In our case, we describe the removal of an intracardiac radiolucent foreign body in an infant utilizing a combination technique - transesophageal echocardiogram and fluoroscopy.

Point-of-Care Ultrasound to Locate Retained Intravenous Drug Needle in the Femoral Artery

We describe the use of point-of-care ultrasound to localize a retained intravenous drug needle, and subsequent surgical removal without computed tomography.