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

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.

Successful Retrieval of a Broken Aspiration Needle Penetrated into the Right Pulmonary Artery: A Case Report with Experience Sharing

INTRODUCTION

Endobronchial ultrasound-guided transbronchial needle aspiration is increasingly used as a minimally invasive procedure in clinical settings. It is generally regarded as a safe procedure with high diagnostic accuracy. However, a complication involving a needle fracture that penetrated a nearby artery has not been reported during this procedure.

CASE PRESENTATION

A male patient, 58 years of age, underwent endobronchial ultrasound-guided transbronchial needle aspiration for a mediastinal lymph node biopsy at a local hospital. The aspiration needle fractured and penetrated from the right middle segmental bronchus into the right pulmonary artery. The patient was then transferred to our hospital. After conducting repeated chest imaging examinations to confirm the presence of the foreign body and holding multidisciplinary team consultations, we first inserted a deflated balloon catheter near the puncture site in the right middle segmental bronchus. Following the needle retrieval through a flexible bronchoscope, the balloon catheter was inflated to ensure local hemostasis. Follow-up evaluations revealed no further complications for this patient.

CONCLUSION

Intragenic vascular injury can occur during endobronchial ultrasound-guided transbronchial needle aspiration. Careful pre-procedure preparations should be planned to minimize complications. In patients experiencing complications due to needle penetration, consultation and coordination with a multidisciplinary team are essential to ensure the safe retrieval of the broken needle.

Removal of a pulmonary artery foreign body during pulse ablation in a patient with atrial fibrillation: A case report

BACKGROUND

Foreign bodies in the pulmonary circulation have been documented in the literature and are typically caused by interventional procedures. However, reports of pulmonary artery foreign bodies during femoral vein puncture are rare, and there is no description of this complication from the guidewire surface flows into the pulmonary artery during a pulse ablation in a patient with atrial fibrillation.

CASE SUMMARY

We described a case in which a linear foreign body suddenly appeared on fluoroscopy image during pulsed ablation of atrial fibrillation. Multiposition angiography showed that the foreign body was currently lodged in the pulmonary artery but was hemodynamically stable. We then chose to use an interventional approach to remove the foreign body from the pulmonary artery. This foreign body was subsequently confirmed to be from the hydrophilic coating of the guidewire surface. This may be related to the difficulties encountered during the puncture of the femoral vein. This is a rare and serious complication of femoral vein puncture. Therefore, we reported this case in order to avoid a similar situation.

CONCLUSION

Mismatches between interventional devices from different manufacturers used for femoral venipuncture may result in pulmonary artery foreign bodies.

Cephalic Vein Intravascular Foreign Body After a Penetrating Injury: A Case Report

CASE

A 65-year-old man presented with a right forearm metallic foreign body after a projectile injury while using a table saw. The area in question appeared infected prompting a surgical incision and drainage. In the operating room, the metallic foreign body was noted to be entirely intravascular within the lumen of the cephalic vein. It was ultimately removed, and the patient recovered without complication.

CONCLUSION

Although foreign bodies after traumatic injury are common, it is exceedingly rare to encounter an intravascular foreign body. However, the consequences of proximal migration can be devastating and thus should be in the differential diagnosis for all treating surgeons.

Utility of a percutaneous mechanical thrombectomy device in retrieval of an iatrogenic intravascular foreign body

Intravascular foreign bodies can result from endovascular procedures and from other medical implants and devices. A wide variety of techniques and devices have been described for the retrieval of such intravascular foreign bodies in reported studies. In the present report, we have described the case of a patient with a symptomatic left innominate vein deep vein thrombosis who also had a retained catheter fragment from a fractured tunneled infusion catheter in the left innominate vein. Using the Inari ClotTriever system (Inari Medical, Irvine, CA), we were able to, not only restore venous outflow by treating the acute deep vein thrombosis, but also retrieve the fragments of the fractured catheter.