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Zhou H, Wang B, Pan J, Qiu C, Yu X, He Y, Zhu Q, Yu L, Wu Z, Li D, Zhang H. Percutaneous snare-retrieval of intracardiac thrombus under fluoroscopic and transesophageal echocardiography guidance: case report and systematic review. Front Cardiovasc Med 2023; 10:1127131. [PMID: 37229221 PMCID: PMC10203901 DOI: 10.3389/fcvm.2023.1127131] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 04/24/2023] [Indexed: 05/27/2023] Open
Abstract
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.
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Affiliation(s)
- Huaji Zhou
- Department of Vascular Surgery, The NO.1 People’s Hospital of Pinghu, Jiaxing, China
- Department of Vascular Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Bing Wang
- Department of Vascular Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Jun Pan
- Department of Vascular Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Chenyang Qiu
- Department of Vascular Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Xinyu Yu
- Department of Vascular Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yangyan He
- Department of Vascular Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Qianqian Zhu
- Department of Vascular Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Lei Yu
- Department of Vascular Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Ziheng Wu
- Department of Vascular Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Donglin Li
- Department of Vascular Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Hongkun Zhang
- Department of Vascular Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
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Divakaran S, Meissner MH, Kohi MP, Chen S, Song Y, Hawkins BM, Rosenfield K, Parikh SA, Secemsky EA. Utilization of and Outcomes Associated with Intravascular Ultrasound during Deep Venous Stent Placement among Medicare Beneficiaries. J Vasc Interv Radiol 2022; 33:1476-1484.e2. [PMID: 35998803 PMCID: PMC9758974 DOI: 10.1016/j.jvir.2022.08.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 07/07/2022] [Accepted: 08/11/2022] [Indexed: 10/15/2022] Open
Abstract
PURPOSE To evaluate temporal trends, practice variation, and associated outcomes with the use of intravascular ultrasound (US) during deep venous stent placement among Medicare beneficiaries. MATERIALS AND METHODS All lower extremity deep venous stent placement procedures performed between January 1, 2017, and December 31, 2019 among Medicare beneficiaries were included. Temporal trends in intravascular US use were stratified by procedural setting and physician specialty. The primary outcome was a composite of 12-month all-cause mortality, all-cause hospitalization, or repeat target vessel intervention. The secondary outcome was a composite of 12-month stent thrombosis, embolization, or restenosis. RESULTS Among the 20,984 deep venous interventions performed during the study period, 15,184 (72.4%) utilized intravascular US. Moderate growth in intravascular US use was observed during the study period in all clinical settings. There was a variation in the use of intravascular US among all operators (median, 77.3% of cases; interquartile range, 20.0%-99.2%). In weighted analyses, intravascular US use during deep venous stent placement was associated with a lower risk of both the primary (adjusted hazard ratio, 0.72; 95% confidence interval [CI], 0.69-0.76; P < .001) and secondary (adjusted hazard ratio, 0.32; 95% CI, 0.27-0.39; P < .001) composite end points. CONCLUSIONS Intravascular US is frequently used during deep venous stent placement among Medicare beneficiaries, with further increase in use from 2017 to 2019. The utilization of intravascular US as part of a procedural strategy was associated with a lower cumulative incidence of adverse outcomes after the procedure, including venous stent thrombosis and embolization.
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Affiliation(s)
- Sanjay Divakaran
- Division of Cardiovascular Medicine and Cardiovascular Imaging Program, Brigham and Women's Hospital, Boston, Massachusetts; Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts. https://twitter.com/SanjayDivakaran
| | - Mark H Meissner
- Department of Surgery, University of Washington School of Medicine, Seattle, Washington
| | - Maureen P Kohi
- Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Siyan Chen
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Yang Song
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Beau M Hawkins
- Section of Cardiovascular Diseases, University of Oklahoma, Oklahoma City, Oklahoma
| | - Kenneth Rosenfield
- Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Sahil A Parikh
- Division of Cardiovascular Medicine, Columbia University Medical Center, New York, New York
| | - Eric A Secemsky
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
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Hosny Sayed DM, Salem DM, Desai KR, O'Sullivan GJ, Black SA. A review of the incidence, outcome and management of venous stent migration. J Vasc Surg Venous Lymphat Disord 2022; 10:482-490. [PMID: 35026448 DOI: 10.1016/j.jvsv.2021.07.015] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 07/22/2021] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Percutaneous endovenous stenting has emerged during the last decade as the primary method of treating symptomatic venous outflow obstruction. A recognised complication of venous stenting is stent migration. The aim of this systematic review was to identify the number of cases reported in the published literature describing stent migration, to recognise risk factors that may be associated with this complication, and outcomes following migration. METHODS A review was conducted following MOOSE and PRIMSA guidelines and registered on PROSPERO. MEDLINE, EMBASE, and PubMed databases and key references were searched using specified keywords. All relevant data for primary procedure and subsequent presentation with stent migration was retrieved. Data was assessed as too low quality to allow for statistical analysis. RESULTS Between 1994 and 2020, 31 articles were identified comprised of 29 case reports and 2 case series providing data for 54 events of venous stent migration with 47/54 providing some data for stent used. Mean age of patients in who migration occurred was 50 years (range 19-88) and 57.6% (n=30) were male. Most reported cases were 60mm or less in length (38/46, 82.6%) and only 3 of the reports were stents greater than 14mm in diameter (3/47, 3.6%). None of the papers reported migration of stents of more than 100mm in length. In 85% of the migrated stent events, retrieval was attempted with 56% via an endovascular approach. The immediate outcome was satisfactory in 100% of the reported attempts whether by endovascular or open surgical approaches. CONCLUSIONS This literature review would suggest that the risk of migration is rare but may be underreported. The majority of reported cases are shorter and smaller diameter stents. The paucity of published data and the short term follow up provided suggest more formal data collection would provide a truer reflection of incidence however clear strategies to avoid migration need to be followed to prevent this complication from occurring.
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Affiliation(s)
- Dr Mohamed Hosny Sayed
- Department of Vascular Surgery, Level 1 North Wing Guys & St Thomas' NHS Foundation Trust, St Thomas' Hospital, Westminster Bridge Rd, London, SE1 7EH
| | - Dr Murtaza Salem
- Department of Vascular Surgery, Level 1 North Wing Guys & St Thomas' NHS Foundation Trust, St Thomas' Hospital, Westminster Bridge Rd, London, SE1 7EH
| | - Kush R Desai
- Department of Radiology, Northwestern University Feinberg School of Medicine, 676 N. St. Clair, Suite 800, Chicago, IL, 60611, USA
| | | | - Stephen A Black
- Department of Vascular Surgery, Level 1 North Wing Guys & St Thomas' NHS Foundation Trust, St Thomas' Hospital, Westminster Bridge Rd, London, SE1 7EH.
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Badesha AS, Siddiqui MM, Bains BRS, Bains PRS, Khan T. A systematic review on the incidence of stent migration in the treatment of acute and chronic iliofemoral disease using dedicated venous stents. Ann Vasc Surg 2022; 83:328-348. [DOI: 10.1016/j.avsg.2021.12.084] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 12/29/2021] [Accepted: 12/31/2021] [Indexed: 12/20/2022]
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Wu K, Lai H, Liu Y, Zhang B. Percutaneous transvenous retrieval of fractured catheter in cancer patients receiving chemotherapy. JOURNAL OF X-RAY SCIENCE AND TECHNOLOGY 2018; 26:1029-1037. [PMID: 30320599 DOI: 10.3233/xst-180430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To explore the clinical efficacy and safety of percutaneous transvenous retrieval of intravascular fractured catheter and to evaluate the possible reasons and final results in cancer patients. METHODS A dataset of 19 patients was used. Percutaneous transvenous retrieval of intravascular fractured catheter was performed in each patients. Clinical data was retrospectively analyzed with respect to the efficacy, safety and outcome, and chest radiography was performed to verify that no catheter fragments were left. RESULTS Two cases had peripherally inserted central catheter and 17 had subcutaneous implanted port catheter. The catheter fragments were located in the brachiocephalic vein-superior vena cava (n = 1), superior vena cava (n = 1), superior and inferior vena cava (n = 1), superior vena cava-right atrium (n = 2), brachiocephalic vein-superior vena cava-right atrium (n = 1), superior vena cava-right atrium-right ventricle (n = 6), brachiocephalic vein-superior vena cava-right atrium and right ventricle (n = 1) and pulmonary artery (n = 6), respectively. All of these catheter fragments were retrieved successfully. No complications such as bleeding and thrombosis were found. CONCLUSION Percutaneous transvenous retrieval is a safe, minimally invasive and relatively simple procedure for the patients with fractured catheter and should be recommended as the first choice.
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Affiliation(s)
- Ketong Wu
- Department of Radiology, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Haiyang Lai
- Department of Radiology, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yang Liu
- Department of Radiology, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Bo Zhang
- Department of Radiology, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
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