Retrieval of impacted broken balloon by balloon inflation in guiding catheter

Endovascular retrieval of an entrapped balloon in a tibial artery

Balloon entrapment is a rare complication of angioplasty in calcified or recalcitrant lesions. A 65-year-old man with chronic limb-threatening ischemia underwent balloon angioplasty of his heavily calcified tibial arteries with a low-profile, tapered, compliant balloon. The balloon became entrapped within the posterior tibial artery and required multiple endovascular maneuvers to deflate and separate the balloon from the calcified arterial wall. This case report describes several adjunctive techniques for retrieval of an entrapped balloon in small, calcified arteries before consideration of surgical removal. These techniques allow for minimally invasive retrieval and continuation of endovascular treatment thereafter.

Balloon rupture with eversion during innominate vein angioplasty requiring surgical retrieval

Balloon rupture during angioplasty can with calcified or recalcitrant lesions. A 61-year-old woman presented with worsening arm and facial swelling. She had a history of left upper extremity thrombolysis and stenting of the innominate vein 6 years prior. Venography showed severe in-stent stenosis. After crossing the lesion, a 12-mm balloon was inflated, which ruptured at nominal pressure. The balloon became stuck and could not be moved over the wire even after retraction of the sheath. A limited surgical cutdown was performed, and the balloon and the wire were removed together. The ruptured balloon part was found to be everted and circumferentially wrapped around the wire, preventing the wire exchange. After cutting the everted portion of the balloon, the catheter was removed without losing wire access. A high-pressure balloon was subsequently used to treat the lesion successfully. Her symptoms had resolved on follow-up, and the stent remained patent after 6 months.

Inline balloon-assisted vascular sheath fragment removal

Background

Unretrievable foreign bodies are associated with high morbidity and mortality. While the majority of reported cases involve the venous circulation, intra-arterial foreign body displacement have the potential to migrate more distally with a higher risk for dissection and hemorrhagic complications during retrieval. As the number of intravascular procedures continues to increase, there is also likely to be a concomittant increase in the number of retrieval procedures, particular for fractured catheters and sheaths. Although snaring is frequently the traditional, ‘go-to’ method for retrieval, there are inherent risks of further dislodgement or fracture.

Case report

We describe a case that involves retrieval of a fractured sheath that originated in the common femoral artery but migrated into the popliteal artery. Different retrieval approaches were employed, however ultimately balloon assisted, over-the-wire retrieval was the successful approach.

Conclusions

We anticipate that over-the-wire, inline-retrieval approaches will continue to grow in popularity and use, particularly with respect to manipulation within the arterial circulation.

Angioplasty Balloon Entrapped Fully Inflated and Detached Within the Left Main Coronary Artery

Described is a complication of rescue left main coronary stenting due to threatened left main closure following a "valve in valve" TAVR procedure. Left main stent post dilatation with a NC Trek balloon was complicated by a failure to deflate the balloon. The patient spiraled into cardiogenic shock and was stabilized by an intra-aortic balloon pump. Attempts to withdraw the balloon resulted in shearing of the balloon off the shaft. Parallel wiring and sequential balloon dilatations allowed left main bifurcation stenting while crushing the inflated balloon underneath the stent's struts. Follow up of 13 months was uneventful. The management of entrapped inflated coronary balloon is reviewed.

Ultrasound-guided percutaneous retrieval of transected radial artery catheter

OBJECTIVE

To report our technique for percutaneous ultrasound-guided retrieval of accidentally transected arterial lines.

CASES DESCRIPTION

Two patients are reported herein; in both of these patients, a part of the 20-gauge catheter inserted for invasive monitoring of their blood pressure in the intensive care unit was accidentally transected with part of the catheter remaining in the radial artery. Both patients were initially asymptomatic; therefore, a minimally invasive technique was sought to remove the catheters without inducing significant risk. Under local anesthesia and ultrasound guidance at the patient bedside, a 6Fr slender sheath was introduced and with the help of a Fogarty catheter in one case, and in the other case, a 0.014-in hydrophobic wire was used to cannulate the catheter, and it was withdrawn into the sheath and removed with it uneventfully.

Retained Coronary Balloon Requiring Emergent Open Surgical Retrieval: An Uncommon Complication Requiring Individualized Management Strategies

The entrapment of coronary intervention devices within the coronary vasculature is a rare but potentially devastating procedural complication. We report a case of an entrapped balloon and broken shaft that had to be retrieved by an open surgical approach. When device extraction is indicated and the use of snaring equipment is unsuccessful or inappropriate, a number of alternative percutaneous maneuvers can be attempted. These include (1) simple advancement and withdrawal of a trapped balloon, (2) use of a "buddy" wire to straighten the vessel and free the trapped device, (3) inflation of a buddy balloon adjacent to a trapped primary balloon to free the device, (4) partial inflation of a buddy balloon distal to a trapped device followed by gentle withdrawal, (5) use of an in-guide secondary balloon to trap the lost device, (6) advancement and twisting of guidewires to entwine the lost device, (7) saline dilution of trapped balloons, and (8) anchoring balloon and reverse-wire puncture of an undeflated and entrapped primary balloon. Careful consideration of various device retrieval strategies is indicated before resorting to open surgical retrieval in the rare instance of intracoronary device entrapment.

Catheter-Assisted Balloon-Supported Retrieval of a Broken Semi-Compliant Balloon from a Coronary Artery

Incidents of broken balloon in a coronary vasculature during percutaneous coronary angioplasty are very rare. Such events in cath-lab may create panic and can be life threatening for patients. Hence, immediate retrieval of broken balloon becomes vital. Here, we report an unusual complication of broken balloon in the mid portion of the left anterior descending coronary artery, which had a calcified and totally occluded in-stent restenotic lesion. The broken balloon was retrieved successfully with no eventual complication using a simple catheter-assisted balloon-supported retrieval technique. The present case highlights the need for interventional cardiologist to be acquainted with different retrieval techniques.