1
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Wang G, Zhao Z, Zhou G, Feng Z. Surgical removal of a peripheral venous catheter fragment in the heart in a preterm infant. J Cardiothorac Surg 2024; 19:306. [PMID: 38822410 PMCID: PMC11140915 DOI: 10.1186/s13019-024-02818-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 05/25/2024] [Indexed: 06/03/2024] Open
Abstract
Peripheral venous catheter fracture with cardiovascular embolization is a rare but potentially serious complication. Herein, we report a case of peripheral venous catheter fracture with embolization in right ventricle in a preterm infant. The catheter fragment was successfully removed by surgical procedure via median sternotomy under cardiopulmonary bypass(CPB).We hope this case will increase awareness of this rare complication and improve cannulation safety.
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Affiliation(s)
- Gang Wang
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, 510515, China
- Department of Pediatric Cardiac Surgery, The Seventh Medical Center of the PLA General Hospital, Beijing, China
| | - Zhe Zhao
- Department of Pediatrics, The Seventh Medical Center of the PLA General Hospital, No.5 Nanmencang Road, Dongcheng District, Beijing, 100700, China
| | - Gengxu Zhou
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, 510515, China
- Department of Pediatric Cardiac Surgery, The Seventh Medical Center of the PLA General Hospital, Beijing, China
| | - Zhichun Feng
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, 510515, China.
- Department of Pediatrics, The Seventh Medical Center of the PLA General Hospital, No.5 Nanmencang Road, Dongcheng District, Beijing, 100700, China.
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2
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Kamisako A, Ikoma A, Suzuki T, Kakimoto N, Suenaga T, Tokuhara D, Sonomura T. Successful retrieval of a foreign body in an infant's right pulmonary artery using the new boomerang loop-snare technique: A case report. Radiol Case Rep 2024; 19:1965-1969. [PMID: 38434777 PMCID: PMC10909603 DOI: 10.1016/j.radcr.2024.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Accepted: 02/05/2024] [Indexed: 03/05/2024] Open
Abstract
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.
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Affiliation(s)
- Atsufumi Kamisako
- Department of Radiology, Wakayama Medical University, 811-1 Kimiidera, Wakayama, Wakayama 641-8509, Japan
| | - Akira Ikoma
- Department of Radiology, Wakayama Medical University, 811-1 Kimiidera, Wakayama, Wakayama 641-8509, Japan
| | - Takayuki Suzuki
- Department of Pediatrics, Wakayama Medical University, 811-1 Kimiidera, Wakayama, Wakayama 641-8509, Japan
| | - Nobuyuki Kakimoto
- Department of Pediatrics, Wakayama Medical University, 811-1 Kimiidera, Wakayama, Wakayama 641-8509, Japan
| | - Tomohiro Suenaga
- Department of Pediatrics, Wakayama Medical University, 811-1 Kimiidera, Wakayama, Wakayama 641-8509, Japan
| | - Daisuke Tokuhara
- Department of Pediatrics, Wakayama Medical University, 811-1 Kimiidera, Wakayama, Wakayama 641-8509, Japan
| | - Tetsuo Sonomura
- Department of Radiology, Wakayama Medical University, 811-1 Kimiidera, Wakayama, Wakayama 641-8509, Japan
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3
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Choi YS, Oh CH. Successful Removal of a Fractured Desilets-Hoffman Sheath in a Patient With a Loop Arteriovenous Graft: Balloon-Supported Retrieval Technique. Vasc Endovascular Surg 2024; 58:448-451. [PMID: 37978848 DOI: 10.1177/15385744231217617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
INTRODUCTION While a Desilets-Hoffman sheath rarely fractures, when it does, the presence of an intravenous foreign body can cause various complications. CASE PRESENTATION A 74-year-old woman receiving hemodialysis for end-stage renal disease via a left forearm arteriovenous graft (AVG) was referred to the interventional radiology department following thrombotic occlusion of the AVG. A corrective procedure was initiated, and the 7F Desilets-Hoffman sheath fractured after the purse-string suture. A .035-inch guidewire was passed through the fractured sheath, and a 3.0-mm x 60-mm balloon catheter was inflated, allowing for the successful removal of the sheath fragment without complications. CONCLUSION The fractured Desilets-Hoffman sheath was successfully removed in a patient with a loop arteriovenous graft using balloon-supported retrieval technique.
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Affiliation(s)
- Yoon Seo Choi
- Department of Radiology, Ewha Womans University Mokdong Hospital, College of Medicine, Ewha Womans University, Seoul, Republic of Korea
| | - Chang Hoon Oh
- Department of Radiology, Ewha Womans University Mokdong Hospital, College of Medicine, Ewha Womans University, Seoul, Republic of Korea
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Mao Q, Lv Z, Han Q, Zhang W. Value of multiplanar reconstruction in multi-slice computed tomography for the detection of foreign body in the pulmonary artery: a case report. J Int Med Res 2024; 52:3000605241237890. [PMID: 38497130 PMCID: PMC10946078 DOI: 10.1177/03000605241237890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Accepted: 02/21/2024] [Indexed: 03/19/2024] Open
Abstract
Multi-slice computed tomography (MSCT) is the primary method for the detection and visualization of foreign bodies in the pulmonary artery because it provides high sensitivity and accuracy. It is very difficult to diagnose a patient with a non-iatrogenic pulmonary artery foreign body who does not have a history of a penetrating trauma. This case report describes a 36-year-old male that presented with coughing and haemoptysis. Based on conventional coronal and cross-sectional CT, the foreign body was misdiagnosed as pulmonary tuberculosis and pulmonary artery thrombosis. During treatment of the bronchial artery embolization and anti-tuberculosis therapy, the patient continued to experience haemoptysis. After further analysis of the pulmonary artery CT angiography images and curved multiplane reconstruction, an approximately 6-cm long toothpick was identified in the pulmonary artery with an unclear entry route. After surgery to remove the toothpick, symptoms of coughing and haemoptysis were resolved. This current case demonstrated that multiplane reconstruction in MSCT can improve the detection and visualization of pulmonary artery foreign bodies, which can aid in the diagnosis of pulmonary artery diseases of unknown cause.
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Affiliation(s)
- Qinxiang Mao
- Department of Radiology, Liuzhou People’s Hospital Affiliated to Guangxi Medical University, Liuzhou, Guangxi Zhuang Autonomous Region, China
| | - Zheng Lv
- Department of Radiology, Liuzhou People’s Hospital Affiliated to Guangxi Medical University, Liuzhou, Guangxi Zhuang Autonomous Region, China
| | - Qiuli Han
- Department of Radiology, Liuzhou People’s Hospital Affiliated to Guangxi Medical University, Liuzhou, Guangxi Zhuang Autonomous Region, China
| | - Wei Zhang
- Department of Radiology, Liuzhou People’s Hospital Affiliated to Guangxi Medical University, Liuzhou, Guangxi Zhuang Autonomous Region, China
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5
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Kasai Y, Haraguchi T, Kitai T, Morita J, Tsujimoto M, Kasai J, Fujita T. Successful transvenous retrieval of an electrode ring dislodged from a novel visualized steerable sheath by inflation of a balloon inside the ring. J Cardiol Cases 2024; 29:63-66. [PMID: 38362578 PMCID: PMC10865133 DOI: 10.1016/j.jccase.2023.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 09/15/2023] [Accepted: 10/11/2023] [Indexed: 02/17/2024] Open
Abstract
The VIZIGO sheath (Biosense Webster, Irvine, CA, USA) is used for catheter ablation (CA) of atrial arrhythmia. In this case report, we describe a complication associated with the VIZIGO sheath and present a successful bailout method. An 82-year-old woman with paroxysmal atrial fibrillation (AF) and atrial tachycardia (AT) was referred to our hospital after experiencing palpitations for 6 months. She underwent CA using the VIZIGO sheath and a fixed Swartz sheath (St. Jude Inc., St. Paul, MN, USA). Pulmonary vein isolation and left atrial posterior wall isolation were performed to address AF and AT. Following ablation, the Swartz sheath was removed; however, the VIZIGO sheath showed resistance to removal. A wire was inserted into the VIZIGO sheath for removal, but the distal electrode ring detached in the vessel. To retrieve the electrode ring, a Mustang over-the-wire angioplasty balloon was dilated inside the ring and withdrawn with the ring. After venography and confirmation of a hemostatic seal, the ablation procedure was completed. The patient experienced postoperative anemia, which was resolved by erythrocyte transfusion. No further paroxysmal AF or AT occurred during the 1-year follow-up. In conclusion, the VIZIGO sheath's distal electrode ring may become detached during CA, and the detached ring can be successfully retrieved using our original bailout technique. Learning objective This case report highlights the unique complication of electrode ring detachment associated with the novel visualized steerable sheath (VIZIGO; Biosense Webster, Irvine, CA, USA) during catheter ablation procedures and presents the successful technique as a bailout method for retrieving the dislodged ring. The technique involves dilating a non-compliant over-the-wire angioplasty balloon inside the ring and withdrawing it along with the detached ring.
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Affiliation(s)
- Yuhei Kasai
- Department of Cardiovascular Medicine, Sapporo Cardiovascular Clinic, Sapporo, Japan
| | - Takuya Haraguchi
- Department of Cardiovascular Medicine, Sapporo Cardiovascular Clinic, Sapporo, Japan
| | - Takayuki Kitai
- Department of Cardiovascular Medicine, Sapporo Cardiovascular Clinic, Sapporo, Japan
| | - Junji Morita
- Department of Cardiovascular Medicine, Sapporo Cardiovascular Clinic, Sapporo, Japan
| | - Masanaga Tsujimoto
- Department of Cardiovascular Medicine, Sapporo Cardiovascular Clinic, Sapporo, Japan
| | - Jungo Kasai
- Toyota Technological Institute at Chicago, Chicago, IL, USA
| | - Tsutomu Fujita
- Department of Cardiovascular Medicine, Sapporo Cardiovascular Clinic, Sapporo, Japan
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6
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Jensen Rahbek LS, Hjortdal A, Rawashdeh YF. Surgical retrieval of transected umbilical vein catheter in an extremely preterm neonate. BMJ Case Rep 2023; 16:e257355. [PMID: 38129078 DOI: 10.1136/bcr-2023-257355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023] Open
Abstract
Umbilical catheters are used in the care of critically ill neonates for intravenous treatment. It is generally considered a safe procedure, although complications can occur. Of these, catheter breakage and intravenous migration are rare but potentially life-threatening events. Due to the low frequency of which these events occur, obtaining detailed descriptions of removal techniques can pose a challenge. Here, we describe a case of a broken umbilical vein catheter and the surgical retrieval of the retained fragment. We also present a thorough literature search of cases of broken umbilical catheters and the method by which they were removed.
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Affiliation(s)
| | - Anders Hjortdal
- General Medicine, Aarhus University Department of Clinical Medicine, Aarhus, Denmark
| | - Yazan F Rawashdeh
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Urology, Aarhus University Hospital, Aarhus, Denmark
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7
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Duman D, Aykan HH, Ertuğrul İ, Ardiçli B, Aypar E, Alehan D, Karagöz T. Percutaneous Transcatheter Retrieval of Central Venous Port Fragments in Pediatric Patients; A Single-center Experience From the Pediatric Cardiology Department. J Pediatr Hematol Oncol 2023; 45:e959-e965. [PMID: 37782316 DOI: 10.1097/mph.0000000000002761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 09/04/2023] [Indexed: 10/03/2023]
Abstract
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.
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Affiliation(s)
- Derya Duman
- Department of Pediatric Cardiology, Mersin University, Mersin
| | | | | | - Burak Ardiçli
- Department of Pediatric Surgery, Hacettepe University, Ankara, Turkey
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8
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Kasai Y, Kasai J, Haraguchi T, Kitai T, Morita J, Okada T, Tsujimoto M, Fujita T. Lock and dock: Two-step transvenous retrieval of a fractured femoral sheath with a vascular snare via the right internal jugular vein. J Cardiol Cases 2023; 28:176-179. [PMID: 37818439 PMCID: PMC10562096 DOI: 10.1016/j.jccase.2023.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 06/08/2023] [Accepted: 06/09/2023] [Indexed: 10/12/2023] Open
Abstract
An 86-year-old male with progressive palpitations and dyspnea was referred to our hospital for heart failure treatment. Catheter ablation was performed for atrial flutter as we suspected tachycardia-induced cardiomyopathy as the cause of the patient's heart failure. Due to difficulty securing a peripheral venous route, a 6-Fr sheath was inserted via the right common femoral vein prior to administering general anesthesia. While attempting to insert a mapping catheter, the 6-Fr sheath became lodged and subsequently fractured during removal. Percutaneous transvenous retrieval using an 8-Fr sheath was unsuccessful, and a switch to a right internal jugular vein approach with a 16-Fr sheath was necessary for successful retrieval. The following two-step retrieval ("lock and dock") was then performed: 1) lock: a vascular snare was used to catch the remaining wire crossing into the fractured sheath lumen to prevent the risk of sheath migration to the right ventricle or the pulmonary artery, and 2) dock: the same snare was subsequently used to catch the fractured sheath. The planned catheter ablation was then successfully performed, without any complications. Learning objective Our case presents, "lock and dock," a novel approach for percutaneous transvenous retrieval that involves two steps: a vascular snare is used to catch the wire and subsequently the fractured sheath. This use of a vascular snare and a large-diameter sheath through the right internal jugular vein effectively reduces the possibility of fractured sheath migration.
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Affiliation(s)
- Yuhei Kasai
- Department of Cardiology, Asia Medical Group, Sapporo Heart Center, Sapporo Cardiovascular Clinic, Sapporo, Japan
| | - Jungo Kasai
- Paul G. Allen School of Computer Science & Engineering, University of Washington, Seattle, WA, USA
| | - Takuya Haraguchi
- Department of Cardiology, Asia Medical Group, Sapporo Heart Center, Sapporo Cardiovascular Clinic, Sapporo, Japan
| | - Takayuki Kitai
- Department of Cardiology, Asia Medical Group, Sapporo Heart Center, Sapporo Cardiovascular Clinic, Sapporo, Japan
| | - Junji Morita
- Department of Cardiology, Asia Medical Group, Sapporo Heart Center, Sapporo Cardiovascular Clinic, Sapporo, Japan
| | - Takuya Okada
- Department of Clinical Engineering, Asia Medical Group, Sapporo Heart Center, Sapporo Cardiovascular Clinic, Sapporo, Japan
| | - Masanaga Tsujimoto
- Department of Cardiology, Asia Medical Group, Sapporo Heart Center, Sapporo Cardiovascular Clinic, Sapporo, Japan
| | - Tsutomu Fujita
- Department of Cardiology, Asia Medical Group, Sapporo Heart Center, Sapporo Cardiovascular Clinic, Sapporo, Japan
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9
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Fiore G, Stella S, Conversano A, Agricola E. An Unusual Cause of Stroke: A "Forgotten" Intracardiac Catheter Discovered After 48 Years. JACC Case Rep 2022; 6:101668. [PMID: 36704064 PMCID: PMC9871056 DOI: 10.1016/j.jaccas.2022.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 09/26/2022] [Accepted: 10/06/2022] [Indexed: 11/06/2022]
Abstract
A 48-year-old man with recurrent cerebral ischemic events underwent transesophageal echocardiography to investigate cardioembolic sources because transthoracic echocardiography had spotted a dubious filamentous mass on the mitral valve. A venous umbilical catheter, lost during the hospital stay after his birth, was surprisingly identified in his cardiac chambers. (Level of Difficulty: Beginner.).
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Affiliation(s)
- Giorgio Fiore
- Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Italy,Unit of Cardiovascular Imaging, IRCCS San Raffaele Scientific Institute, Milan, Italy,Address for correspondence: Dr. Giorgio Fiore, Department of Clinical Cardiology, Vita-Salute San Raffaele University, Via Olgettina 60, 20132 Milano, Italy.
| | - Stefano Stella
- Unit of Cardiovascular Imaging, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Andrea Conversano
- Unit of Cardiovascular Imaging, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Eustachio Agricola
- Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Italy,Unit of Cardiovascular Imaging, IRCCS San Raffaele Scientific Institute, Milan, Italy
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10
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Wang F, Li T, Yuan X, Hu J. Entrapment of a metal foreign body in the heart during surgical procedure: A case report and literature review. Front Surg 2022; 9:963021. [PMID: 36204339 PMCID: PMC9530267 DOI: 10.3389/fsurg.2022.963021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 08/29/2022] [Indexed: 11/13/2022] Open
Abstract
A rongeur had been used to remove thin bones in both orthopedic surgery and neurosurgery, featured with a tip holding and cutting bone effectively while protecting the underlying instruments. The authors describe a case of a 40-year-old man who proceeded with the second lumbar vertebrae osteotomy and presented to be ankylosing spondylitis with kyphosis and limited mobility for 10 years. During the surgery, we found that the rongeur tip was missing. C-arm fluoroscopy showed the high-density body just in front of the vertebral body intraoperatively. However, the CT scan showed the foreign body migrated to the right auricle of the heart postoperatively. This case is unique in that there was no exact vessel injury detected intraoperatively. There were few reports about the surgical instrument migrating to the heart. Our case showed the rare experience of the function of multidisciplinary collaboration in the migration of foreign bodies in the cervical spinal canal.
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Affiliation(s)
- Fei Wang
- The Orthopaedic Surgery Department of Sichuan Academy of Medical Sciences / Sichuan Provincial People’s Hospital, The Affiliated Hospital of University of Electronic Science and Technology of China, Chengdu, China
| | - Ting Li
- The Orthopaedic Surgery Department of Sichuan Academy of Medical Sciences / Sichuan Provincial People’s Hospital, The Affiliated Hospital of University of Electronic Science and Technology of China, Chengdu, China
- Department of Postgraduate, Chengdu Medical College, Chengdu, China
| | - Xinwei Yuan
- The Orthopaedic Surgery Department of Sichuan Academy of Medical Sciences / Sichuan Provincial People’s Hospital, The Affiliated Hospital of University of Electronic Science and Technology of China, Chengdu, China
| | - Jiang Hu
- The Orthopaedic Surgery Department of Sichuan Academy of Medical Sciences / Sichuan Provincial People’s Hospital, The Affiliated Hospital of University of Electronic Science and Technology of China, Chengdu, China
- Correspondence: Jiang Hu
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11
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Saleem T. Utility of a percutaneous mechanical thrombectomy device in retrieval of an iatrogenic intravascular foreign body. J Vasc Surg Cases Innov Tech 2022; 8:506-509. [PMID: 36052214 PMCID: PMC9424359 DOI: 10.1016/j.jvscit.2022.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 07/13/2022] [Indexed: 11/20/2022] Open
Abstract
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.
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Affiliation(s)
- Taimur Saleem
- Correspondence: Taimur Saleem, MBBS, FACS, The RANE Center for Venous and Lymphatic Diseases, St. Dominic Hospital, 971 Lakeland Dr, Ste 401, Jackson, MS 39216
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12
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Çil E, Şahin KE. Pulmonary embolism due to an indefinite plug: 5-year follow-up. Interact Cardiovasc Thorac Surg 2022; 35:6650651. [PMID: 35894799 PMCID: PMC9338705 DOI: 10.1093/icvts/ivac202] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 07/06/2022] [Accepted: 07/25/2022] [Indexed: 11/14/2022] Open
Abstract
Abstract
Thoracic computed tomography angiography revealed a filling defect with an internal air density in the lower lobar branch of the left pulmonary artery accompanied by pleural fluid, in a patient who applied with sudden onset chest pain and dyspnoea. The filling defect remained stable after anticoagulant treatment. No progression or complications were observed in 5-year follow-up. In pulmonary embolism that does not resolve despite adequate treatment, non-thrombotic sources, particularly foreign body, should be considered.
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Affiliation(s)
- E Çil
- Department of Chest Diseases, Adiyaman University Education and Research Hospital , Adiyaman, Turkey
| | - K E Şahin
- Department of Cardiology, Adiyaman University Education and Research Hospital , Adiyaman, Turkey
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13
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Visser PCJ, Vink MA, Patterson MS, Yazdanbakhsh A, Arlan F, Kuipers RS. Cardiac arrest resulting from an unidentified foreign object, later identified as a balloon cover, within the left anterior descending coronary artery. BMJ Case Rep 2022; 15:e244786. [PMID: 35428662 PMCID: PMC9013957 DOI: 10.1136/bcr-2021-244786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2022] [Indexed: 11/04/2022] Open
Abstract
A 31-year-old man with a history of hypertrophic cardiomyopathy and alcohol septal ablation one week before was presented after an out of hospital cardiac arrest in the setting of an anterior wall ST-elevation myocardial infarction. Immediate coronary angiography showed an unidentified foreign object within the left anterior descending coronary artery (LAD), later identified as the cover of a balloon that had been unintentionally inserted and abandoned within the LAD during the alcohol septum ablation one week earlier. Intracoronary imaging confirmed the presence of endothelial damage and thrombus formation within the LAD explaining acute myocardial infarction. The patient was treated by surgical retrieval of the balloon cover, extended septal myectomy and coronary artery bypass grafting (CABG) of the LAD. This case is both an example of unintentional neglect of unexpected objects, and the importance of multimodality imaging and multidisciplinary teamwork to get to a correct diagnosis and treatment.
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Affiliation(s)
| | - Maarten A Vink
- Department of Cardiology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| | - Mark S Patterson
- Department of Cardiology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| | - Aria Yazdanbakhsh
- Department of Cardiothoracic Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, Noord-Holland, Netherlands
| | - Fatih Arlan
- Department of Cardiology, Sint Antonius Ziekenhuis, Nieuwegein, Utrecht, Netherlands
| | - Remko S Kuipers
- Department of Cardiology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
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14
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Rathod K, Bairy A, Chagla AS, Deshmukh H. Endovascular repositioning and resizing of the distal catheter of a ventriculoatrial shunt. BMJ Case Rep 2022; 15:e248452. [PMID: 35418379 PMCID: PMC9014027 DOI: 10.1136/bcr-2021-248452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/19/2022] [Indexed: 11/04/2022] Open
Abstract
Ventriculoatrial (VA) shunts are an effective alternative to ventriculoperitoneal shunts for diversion of cerebrospinal fluid in patients with hydrocephalus. Accurate placement of the distal end of a VA shunt in the right atrium is imperative for appropriate drainage and can be technically challenging. Misplaced or dislodged shunt catheter needs urgent repositioning, which can be performed by endovascular techniques. We present a case of VA shunt placement related complication, in which the dislodged distal fragment was retrieved by endovascular techniques. The remaining distal catheter, found to be in the internal jugular vein, was not only repositioned, but also resized for accurate placement in the right atrium.
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Affiliation(s)
- Krantikumar Rathod
- Department of Radiology, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Abhishek Bairy
- Department of Radiology, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Aadil Shaukat Chagla
- Department of Neurosurgery, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Hemant Deshmukh
- Department of Radiology, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
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15
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Matsui Y, Asai T, Oishi A, Kamikawa Y, Amano A, Tabata M. Minimally invasive extraction of a catheter from the heart without thoracotomy. Ann Thorac Surg 2022; 114:e451-e453. [DOI: 10.1016/j.athoracsur.2022.02.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 02/02/2022] [Accepted: 02/02/2022] [Indexed: 11/29/2022]
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16
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Beshai R. Watchman Device Procedure Complicated by Rare Perclose ProGlide Embolization: Case Report and Literature Review. Cureus 2022; 14:e21173. [PMID: 35165622 PMCID: PMC8831485 DOI: 10.7759/cureus.21173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/12/2022] [Indexed: 11/23/2022] Open
Abstract
Atrial fibrillation (AF) is the most common cardiac arrhythmia with significant morbidity and mortality. In this case, we present a 69-year-old man with a past medical history of atrial fibrillation on warfarin who came to the hospital for placement of the Watchman device (Boston Scientific Corporation, Marlborough, Massachusetts, United States). His procedure was complicated by Perclose ProGlide™ Suture-Mediated Closure system (Abbott Laboratories Inc., Chicago, Illinois, United States) embolism. The vascular surgery department was consulted STAT in the electrophysiology lab and was unable to fully visualize the vessel. The patient was then brought emergently to a hybrid operating room where venotomy was made. He tolerated the procedure well and was eventually discharged home.
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17
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Tadahito E, Kazutaka H, Yusuke S, Satsuki K, Shinichi M, Takeshi Y, Kenichi W. Retrieving a lost needle in the descending aorta during hemi-arch replacement. Asian Cardiovasc Thorac Ann 2022; 30:848-852. [PMID: 35014878 DOI: 10.1177/02184923211072474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A 73-year-old man diagnosed with moderate aortic insufficiency and dilatation of the aortic root and ascending aorta underwent a modified Bentall procedure and hemi-arch aortic replacement. During open distal anastomosis of the ascending aorta, the surgical needle was lost. Because of circulatory arrest, the operation was continued; before closing the chest, radiography and a transesophageal echo were located in the needle in the descending aorta. It was retrieved using a snare catheter via the graft branch under fluoroscopic guidance. Thus, locating the needle in the descending aorta and leaving the graft branch uncut led to its removal without a new incision.
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Affiliation(s)
- Eda Tadahito
- Department of Cardiovascular Surgery, 13849Okazaki City Hospital, Japan
| | - Horiuchi Kazutaka
- Department of Cardiovascular Surgery, 13849Okazaki City Hospital, Japan
| | - Sakurai Yusuke
- Department of Cardiovascular Surgery, 13849Okazaki City Hospital, Japan
| | - Komoda Satsuki
- Department of Cardiovascular Surgery, 13849Okazaki City Hospital, Japan
| | - Mizutani Shinichi
- Department of Cardiovascular Surgery, 13849Okazaki City Hospital, Japan
| | - Yuasa Takeshi
- Department of Cardiovascular Surgery, 13849Okazaki City Hospital, Japan
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18
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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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19
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Rescue of a patient with a 50 cm broken PICC tube retracted and wrapped in pulmonary artery: a case report. FRONTIERS OF NURSING 2021. [DOI: 10.2478/fon-2021-0045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Objective
With the increasing use of a peripherally inserted central catheter (PICC) in clinical application, the breaking of the PICC is increasing as well, which would turn into the emboli and drift to the heart and pulmonary artery, causing severe consequences. However, few cases have been reported on the rescue of patients with a broken PICC.
Patient concerns
A 33-year-old man, diagnosed with chronic hepatitis B-related decompensated cirrhosis and cryptococcal meningitis, was treated with amphotericin B combined with flucytosine and fluconazole by means of PICC catheterization. The patient was discharged with a catheter; when he returned for re-examination, a 50cm length of PICC broke and slipped into the vein after his sudden dysphoria. First aid was immediately administered, and then the intervention therapy to extricate the tube, including pulmonary artery angiography and intravascular removal of foreign matter, was performed based on the consensus of the in-hospital vein treatment group. At last, the broken PICC fragment was successfully taken out of the vessel. Re-examination after surgery showed that he recovered well.
Conclusions
Once the catheter is broken, the X-ray examination should be performed at the first instance and re-examined frequently. Moreover, the involvement of a multidisciplinary team should be formed to decide the appropriate method of treatment to ensure a successful rescue.
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20
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Leite TFDO, Pazinato LV, Bortolini E, Pereira OI, Nomura CH, Filho JMDML. Endovascular removal of intravascular foreign bodies: A single-center experience and literature review. Ann Vasc Surg 2021; 82:362-376. [PMID: 34936892 DOI: 10.1016/j.avsg.2021.12.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 11/18/2021] [Accepted: 12/01/2021] [Indexed: 11/19/2022]
Abstract
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.
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Affiliation(s)
| | - Lucas Vatanabe Pazinato
- Interventional Radiology Unit, Department of Radiology, University of São Paulo Medical School, São Paulo, Brazil
| | - Edgar Bortolini
- Interventional Radiology, Radiology Department, Heart Institute (InCor), University of São Paulo, São Paulo, Brazil
| | - Osvaldo Ignacio Pereira
- Interventional Radiology Unit, Department of Radiology, University of São Paulo Medical School, São Paulo, Brazil
| | - Cesar Higa Nomura
- Interventional Radiology, Radiology Department, Heart Institute (InCor), University of São Paulo, São Paulo, Brazil
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21
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Georgeades C, Rothstein AE, Plunk MR, Arendonk KV. Iatrogenic vascular trauma and complications of vascular access in children. Semin Pediatr Surg 2021; 30:151122. [PMID: 34930587 DOI: 10.1016/j.sempedsurg.2021.151122] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
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.
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Affiliation(s)
- Christina Georgeades
- Division of Pediatric Surgery, Children's Wisconsin and Medical College of Wisconsin, 999N 92nd Street, Suite 320, Milwaukee, WI 53226, United States.
| | - Abby E Rothstein
- Division of Vascular and Endovascular Surgery, Department of Surgery, Medical College of Wisconsin, 8701W. Watertown Plank Road, Milwaukee, WI 53226, United States
| | - Matthew R Plunk
- Department of Radiology, Children's Wisconsin and Medical College of Wisconsin, 9000W. Wisconsin Avenue, MS-721, Milwaukee, WI 53226, United States
| | - Kyle Van Arendonk
- Division of Pediatric Surgery, Children's Wisconsin and Medical College of Wisconsin, 999N 92nd Street, Suite 320, Milwaukee, WI 53226, United States
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22
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McClintock S, Biggs N, North D. Femoral thromboendarterectomy and retrieval of an angioplasty balloon: an unusual case of an intra-vascular foreign body. ANZ J Surg 2021; 92:1927-1929. [PMID: 34825762 DOI: 10.1111/ans.17396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 09/30/2021] [Accepted: 10/26/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Samuel McClintock
- Department of Vascular Surgery, University Hospital Geelong, Barwon Health, Victoria, Australia
| | - Nathan Biggs
- Department of Vascular Surgery, University Hospital Geelong, Barwon Health, Victoria, Australia
| | - David North
- Department of Vascular Surgery, University Hospital Geelong, Barwon Health, Victoria, Australia
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23
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Doğduş M, Dindaş F, Türkyılmaz E, Dindar B, Tunçer B, Candan Ö. Successful percutaneous transvenous removal of a fractured port catheter via novel technique: Balloon-supported retrieval. Anatol J Cardiol 2021; 25:671-672. [PMID: 34498601 DOI: 10.5152/anatoljcardiol.2021.62186] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Mustafa Doğduş
- Department of Cardiology, Uşak University Training and Research Hospital; Uşak-Turkey
| | - Ferhat Dindaş
- Department of Cardiology, Uşak University Training and Research Hospital; Uşak-Turkey
| | - Erdem Türkyılmaz
- Department of Cardiology, Uşak University Training and Research Hospital; Uşak-Turkey
| | - Barış Dindar
- Department of Cardiology, Uşak University Training and Research Hospital; Uşak-Turkey
| | - Barış Tunçer
- Department of Cardiovascular Surgery, Uşak University Training and Research Hospital; Uşak-Turkey
| | - Özkan Candan
- Department of Cardiology, Uşak University Training and Research Hospital; Uşak-Turkey
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24
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Najari F, Malekpour-Alamdari N, Baradaran Kial I, Najari D, Mirzaei S. Prolonged Fever; a Case Report of Medical Malpractice. ARCHIVES OF ACADEMIC EMERGENCY MEDICINE 2021; 9:e49. [PMID: 34405147 PMCID: PMC8366457 DOI: 10.22037/aaem.v9i1.1217] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Any surgical or preoperative treatment and diagnostic procedure may be associated with complications and risks. Therefore, introduction of complicated cases plays an important role in educating those involved in the diagnosis of patients. Generally, if a physician or a nurse is informed that an item is inadvertently left behind in a patient's body during surgery, he/she is obliged to take action by notifying the healthcare system authorities and informing the patient as soon as possible; otherwise, he/she has committed a disciplinary violation. Here we present a 27-year-old female patient with a history of renal failure with prolonged fever following a retained Shaldon catheter in a patient’s chest.
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Affiliation(s)
- Fares Najari
- Department of Forensic Medicine, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | | | - Dorsa Najari
- School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sahar Mirzaei
- School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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25
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Pazinato LV, Leite TFDO, Bortolini E, Pereira OI, Nomura CH, Motta-Leal-Filho JMD. Percutaneous retrieval of intravascular foreign body in children: a case series and review. Acta Radiol 2021; 63:684-691. [PMID: 33832338 DOI: 10.1177/02841851211006904] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
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.
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Affiliation(s)
- Lucas Vatanabe Pazinato
- Interventional Radiology, Department of Radiology, University of São Paulo Medical School, São Paulo, Brazil
| | | | - Edgar Bortolini
- Interventional Radiology, Department of Radiology, Heart Institute (InCor), University of São Paulo, São Paulo, Brazil
| | | | - Cesar Higa Nomura
- Interventional Radiology, Department of Radiology, Heart Institute (InCor), University of São Paulo, São Paulo, Brazil
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26
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Korosoglou G, Giusca S, Antaredja M, Schmidt A, Blessing E. Distal retrieval of dislodged and migrated guidewires after retrograde puncture of the deep femoral and dorsal pedal artery. A case series. Clin Case Rep 2021; 9:2077-2082. [PMID: 33936643 PMCID: PMC8077260 DOI: 10.1002/ccr3.3948] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 12/21/2020] [Accepted: 01/30/2021] [Indexed: 01/22/2023] Open
Abstract
We report on retrograde retrieval of the soft end of dislodged guidewires during complex interventions. Interventionalists may consider this as an option for the endovascular management of this complication if an antegrade retrieval is not possible or fails.
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Affiliation(s)
| | - Sorin Giusca
- Cardiology & Vascular MedicineGRN Hospital WeinheimWeinheimGermany
| | | | - Andrej Schmidt
- Department of Interventional AngiologyUniversity Hospital LeipzigLeipzigGermany
| | - Erwin Blessing
- Department of Internal MedicineSRH HospitalKarlsbadGermany
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27
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Giniyani LL, Rana YP, J Hanumanthu BK, Chan D, Kwan TW. Perclose ProGlide embolization as a complication: case report and review of literature. Future Cardiol 2021; 17:1193-1197. [PMID: 33448229 DOI: 10.2217/fca-2020-0154] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background: Vascular closure devices have replaced mechanical compression for closure of femoral access sites after endovascular procedures. Case: We present an 87-year old male with symptomatic infrarenal aortic aneurysm measuring 4.8 cm presenting for elective endovascular repair of the aortic aneurysm. A Perclose ProGlide Suture-Mediated Closure was used for closure. The closure was complicated by a separation of the ProGlide device resulting in the migration of the footplate to the descending aorta. Correction required snare retrieval via radial access, and the patient recovered without complications. Discussion: We highlight an important complication of the Perclose ProGlide Suture-Mediated Closure device that is rare but important to know when performing endovascular closures with this device.
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Affiliation(s)
- Larab L Giniyani
- Department of Internal Medicine, Mount Sinai Beth Israel Medical Center, New York, NY 10003, USA
| | - Yesha P Rana
- Department of Internal Medicine, Mount Sinai Beth Israel Medical Center, New York, NY 10003, USA
| | | | - Doris Chan
- Department of Interventional Cardiology, Mount Sinai Morningside, New York, NY 10025, USA
| | - Tak W Kwan
- Department of Interventional Cardiology, Mount Sinai Morningside, New York, NY 10025, USA
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28
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Bodenham A, Lansdown M, Horgan K. Retained port connectors after central venous port removal. J Vasc Access 2021; 23:309-312. [PMID: 33438487 DOI: 10.1177/1129729820987389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
We report three cases where the connector/sleeve, which helps fix the flexible catheter section to a port injection chamber, was inadvertently left in scar tissue during port removal. Concerned patients presented months later with a palpable subcutaneous nodule, near the port site. The nodules were variably imaged with plain X-rays, mammography or ultrasound with the diagnosis correctly made by a surgeon familiar with devices. Two connectors were removed, and one was left in place following discussions with the patient. Prevention, recognition and management of this problem are discussed.
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Affiliation(s)
- Andrew Bodenham
- Departments of Anaesthesia and Surgery, Leeds Teaching Hospitals, Leeds, UK
| | - Mark Lansdown
- Departments of Anaesthesia and Surgery, Leeds Teaching Hospitals, Leeds, UK
| | - Kieran Horgan
- Departments of Anaesthesia and Surgery, Leeds Teaching Hospitals, Leeds, UK
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29
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Ciarrocchi AP, Parisi AM, Campisi A, Mazzarra S, Argnani D, Congiu S, Sanna S, Stella F. A strange case of foreign body embolism in the right lower pulmonary artery. Gen Thorac Cardiovasc Surg 2021; 69:894-896. [PMID: 33400199 PMCID: PMC7783300 DOI: 10.1007/s11748-020-01570-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 12/12/2020] [Indexed: 10/29/2022]
Abstract
Foreign bodies in the pulmonary circulation have been documented in the literature, with almost all cases being iatrogenic, involving venous catheters, or due to penetrating foreign body emboli. Foreign body pulmonary emboli are often difficult to diagnose due to their varied clinical presentation, the nature of the embolizing material and dubious radiological features. We describe the case of a patient who experienced episodes of massive hemoptysis with inconclusive radiological findings, who underwent a thoracotomy with the discovery of a wooden object of 7 cm in length in the right lower lobe artery, with no apparent mechanism of injury.
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Affiliation(s)
- Angelo Paolo Ciarrocchi
- Thoracic Surgery Unit, Department of Thoracic Diseases, G.B. Morgagni-L. Pierantoni Hospital, University of Bologna, 34 Carlo Forlanini Street, 47121, Forli, Italy.
| | - Anna Mariantonia Parisi
- Thoracic Surgery Unit, Department of Thoracic Diseases, G.B. Morgagni-L. Pierantoni Hospital, University of Bologna, 34 Carlo Forlanini Street, 47121, Forli, Italy
| | - Alessio Campisi
- Thoracic Surgery Unit, Department of Thoracic Diseases, G.B. Morgagni-L. Pierantoni Hospital, University of Bologna, 34 Carlo Forlanini Street, 47121, Forli, Italy
| | - Sara Mazzarra
- Thoracic Surgery Unit, Department of Thoracic Diseases, G.B. Morgagni-L. Pierantoni Hospital, University of Bologna, 34 Carlo Forlanini Street, 47121, Forli, Italy
| | - Desideria Argnani
- Thoracic Surgery Unit, Department of Thoracic Diseases, G.B. Morgagni-L. Pierantoni Hospital, University of Bologna, 34 Carlo Forlanini Street, 47121, Forli, Italy
| | - Stefano Congiu
- Thoracic Surgery Unit, Department of Thoracic Diseases, G.B. Morgagni-L. Pierantoni Hospital, University of Bologna, 34 Carlo Forlanini Street, 47121, Forli, Italy
| | - Stefano Sanna
- Thoracic Surgery Unit, Department of Thoracic Diseases, G.B. Morgagni-L. Pierantoni Hospital, University of Bologna, 34 Carlo Forlanini Street, 47121, Forli, Italy
| | - Franco Stella
- Thoracic Surgery Unit, Department of Thoracic Diseases, G.B. Morgagni-L. Pierantoni Hospital, University of Bologna, 34 Carlo Forlanini Street, 47121, Forli, Italy
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30
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Karia N, Balmforth D, Lall K, Gupta S, Bhattacharyya S. Migration of a Varicocele Coil to the Right Heart. JACC Case Rep 2020; 2:2312-2317. [PMID: 34317162 PMCID: PMC8304537 DOI: 10.1016/j.jaccas.2020.07.035] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 07/16/2020] [Indexed: 06/13/2023]
Abstract
We describe a case of an adult patient with embolization of a varicocele coil (7 × 70 mm) to the right ventricle. We review the multimodality imaging techniques used to identify location and the importance of a multidisciplinary approach in determining management. (Level of Difficulty: Advanced.).
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Affiliation(s)
- Nina Karia
- Echocardiography Laboratory, St Bartholomew’s Hospital, London, United Kingdom
| | - Damian Balmforth
- Cardiovascular Surgery, St Bartholomew’s Hospital, London, United Kingdom
| | - Kulvinder Lall
- Cardiovascular Surgery, St Bartholomew’s Hospital, London, United Kingdom
| | - Sandy Gupta
- Whipps Cross Hospital, London, United Kingdom
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31
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Yadav MK, Pillai R, Unni M, Palangadan S, Jain N. Iatrogenic Intravascular Foreign Body Retrieval in a Neonate. JOURNAL OF CLINICAL INTERVENTIONAL RADIOLOGY ISVIR 2020. [DOI: 10.1055/s-0040-1710151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
AbstractThis is a short communication demonstrating a unique method of intravascular foreign body retrieval by grasp from inside technique in a neonate.
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Affiliation(s)
- Manish Kumar Yadav
- Division of Interventional Radiology, Department of Radiology, Kerala Institute of Medical Sciences, Trivandrum, Kerala, India
| | - Ramakrishna Pillai
- Department of Cardiology, Kerala Institute of Medical Sciences, Trivandrum, Kerala, India
| | - Madhavan Unni
- Department of Radiology, Kerala Institute of Medical Sciences, Trivandrum, Kerala, India
| | - Shaji Palangadan
- Department of Cardiothoracic and Vascular Surgery, Kerala Institute of Medical Sciences, Trivandrum, Kerala, India
| | - Naveen Jain
- Department of Neonatology, Kerala Institute of Medical Sciences, Trivandrum, Kerala, India
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32
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Simgen A, Kettner M, Webelsiep FJ, Tomori T, Mühl-Benninghaus R, Yilmaz U, Bhogal P, Laschke MW, Menger MD, Reith W, Dietrich P. Solitaire Stentectomy Using a Stent-Retriever Technique in a Porcine Model. Clin Neuroradiol 2020; 31:475-482. [PMID: 32424667 PMCID: PMC8211602 DOI: 10.1007/s00062-020-00906-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 04/15/2020] [Indexed: 12/18/2022]
Abstract
PURPOSE Mechanical thrombectomy using the Solitaire device has become a standard treatment of ischemic stroke due to large vessel occlusions. Inadvertent detachment is a feared complication, which is associated with poor clinical outcome. The aim of this experimental study was to assess in a porcine model the feasibility and effectiveness of rescuing detached Solitaire devices using different stent retrievers. METHODS Solitaire FR devices (4 × 15/20 mm and 6 × 20/30 mm) were placed in the axillary artery of pigs. By means of 3 different stent retrievers (Trevo ProVue; EmboTrap II revascularization device; 3D revascularization device) a total of 24 rescue maneuvers (8 per retriever) were performed by deploying the retrievers within the deployed Solitaire devices and trapping parts of the Solitaire within the microcatheter. Rescue rates, rescue time and complications were assessed. RESULTS Overall stentectomy of the Solitaire devices was successful in all cases (100%). Time of rescue was comparable using the applied stent retrievers (Trevo ProVue; EmboTrap II revascularization device; 3D revascularization device). Complications, such as entrapment of the Solitaire-retriever complex at the intermediate catheter, Solitaire migration, vasospasm, perforation, or dissection were not observed. CONCLUSION Stentectomy of inadvertently detached Solitaire devices using different stent retrievers is a feasible and effective method. Rescue rates and times with the Trevo ProVue, EmboTrap II and 3D revascularization device were comparable.
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Affiliation(s)
- Andreas Simgen
- Department of Neuroradiology, Saarland University Hospital, Kirrbergerstraße1, 66424, Homburg/Saar, Germany.
| | - Michael Kettner
- Department of Neuroradiology, Saarland University Hospital, Kirrbergerstraße1, 66424, Homburg/Saar, Germany
| | - Frida Juliane Webelsiep
- Department of Neuroradiology, Saarland University Hospital, Kirrbergerstraße1, 66424, Homburg/Saar, Germany
| | - Toshiki Tomori
- Department of Neuroradiology, Saarland University Hospital, Kirrbergerstraße1, 66424, Homburg/Saar, Germany
| | - Ruben Mühl-Benninghaus
- Department of Neuroradiology, Saarland University Hospital, Kirrbergerstraße1, 66424, Homburg/Saar, Germany
| | - Umut Yilmaz
- Department of Neuroradiology, Saarland University Hospital, Kirrbergerstraße1, 66424, Homburg/Saar, Germany
| | - Pervinder Bhogal
- Department of Interventional Neuroradiology, The Royal London Hospital, Whitechapel Road, E1 1BB, London, UK
| | - Matthias W Laschke
- Institute for Clinical & Experimental Surgery, Saarland University Hospital, Homburg/Saar, Germany
| | - Michael D Menger
- Institute for Clinical & Experimental Surgery, Saarland University Hospital, Homburg/Saar, Germany
| | - Wolfgang Reith
- Department of Neuroradiology, Saarland University Hospital, Kirrbergerstraße1, 66424, Homburg/Saar, Germany
| | - Philipp Dietrich
- Department of Neuroradiology, Saarland University Hospital, Kirrbergerstraße1, 66424, Homburg/Saar, Germany
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Successful percutaneous transvenous retrieval of intravascular fractured port catheter: a single center experience. J Cardiothorac Surg 2020; 15:101. [PMID: 32423421 PMCID: PMC7236484 DOI: 10.1186/s13019-020-01131-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 05/04/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Fractured catheter as a foreign body in situ is a rare complication after port catheter placement. We report a single center's experience on percutaneous transvenous retrieval of intravascular fractured port catheter and treatment techniques. METHODS Patients undergoing percutaneous transvenous retrieval of intravascular fractured port catheter from Jan 2010 to Dec 2018 were retrospectively collected. A total of 10 patients (8 females and 2 males) were enrolled in this study. Procedures were performed within 1 day after diagnosis. Two methods of retrieval were considered, direct retrieval by gooseneck snare and guide wire as media to retrieve were used in the procedure. RESULTS All the fractured catheters in 10 patients were successfully retrieval by 2 methods, direct retrieval by gooseneck snare(n = 6) and guide wire as media of retrieval(n = 4). The time interval between port catheter implantation and discovery of catheter fracture was 36.50 ± 42.99(ranged 1 to 146) days. The operation time was 24.10 ± 8.32(ranged 10 to 36) minutes. No immediate procedure related or 1 month follow-up complications occurred in all the 10 patients. CONCLUSION Percutaneous transvenous retrieval of intravascular fractured port catheter is a simple and safe procedure, which maybe recommended as the first choice for patients with fractured port catheter in situ.
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Simgen A, Yilmaz U, Dietrich P, Tomori T, Mühl-Benninghaus R, Laschke MW, Menger MD, Reith W, Kettner M. Rescue of migrated Woven Endobridge devices using a stent-retriever-technique in a porcine model. Interv Neuroradiol 2020; 26:772-778. [PMID: 32340514 DOI: 10.1177/1591019920920984] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE The Woven Endobridge device (WEB) has become widely applied for the treatment of intracranial aneurysms. Complications are rare, however, especially dislocations and migrations can potentially increase poor clinical outcome. The aim of this study was to assess the feasibility and effectiveness of rescuing migrated Woven Endobridges using different stent retrievers. METHODS In a porcine model, Woven Endobridges of different sizes (SLS 4, SLS 7, SL 5 × 3, SL 4 × 3) were placed into the axillary arteries. By means of two different stent retrievers (Solitaire Platinum and 3D Revascularization Device), a total of 20 rescue maneuvers were performed. For this purpose, the retrievers were deployed distally of the migrated Woven Endobridges. After retracting the stent retrievers partially, the Woven Endobridges were trapped within the microcatheter. Rescue rates, time, attempts and complications were assessed. RESULTS Successful rescue of the migrated Woven Endobridges was observed in all cases (100%). Rescue was slightly faster (177.8 ± 72.8 s vs. 223.4 ± 104.1 s) with fewer attempts (1.5 ± 0.8 vs. 1.8 ± 0.9) when using the 3D Revascularization Device compared to the Solitaire Platinum. However, there were no significant differences (p = 0.327; p = 0.554). Migration of the Woven Endobridges during rescue was seen with both stent retrievers in a comparable frequency (p = 0.642). Further complications, such as entrapment of the stent-retriever-WovenEndobridge-complex at the intermediate catheter, vasospasm, perforation or dissection, were not observed. CONCLUSIONS Rescue of migrated Woven Endobridges using stent retrievers is a feasible and effective method. Rescue rates, times and attempts with the Solitaire Platinum and 3D Revascularization Device are comparable with each other.
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Affiliation(s)
- Andreas Simgen
- Department of Neuroradiology, Saarland University Hospital, Homburg/Saar, Germany
| | - Umut Yilmaz
- Department of Neuroradiology, Saarland University Hospital, Homburg/Saar, Germany
| | - Philipp Dietrich
- Department of Neuroradiology, Saarland University Hospital, Homburg/Saar, Germany
| | - Toshiki Tomori
- Department of Neuroradiology, Saarland University Hospital, Homburg/Saar, Germany
| | | | - Matthias W Laschke
- Institute for Clinical & Experimental Surgery, Saarland University, Homburg/Saar, Germany
| | - Michael D Menger
- Institute for Clinical & Experimental Surgery, Saarland University, Homburg/Saar, Germany
| | - Wolfgang Reith
- Department of Neuroradiology, Saarland University Hospital, Homburg/Saar, Germany
| | - Michael Kettner
- Department of Neuroradiology, Saarland University Hospital, Homburg/Saar, Germany
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Nguyen HL, Herrera LN, Cheema A, Sarkar PK. Broken and forgotten: A case of unintentionally retained foreign object. Respir Med Case Rep 2020; 29:101000. [PMID: 32257786 PMCID: PMC7118408 DOI: 10.1016/j.rmcr.2020.101000] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 01/15/2020] [Accepted: 01/16/2020] [Indexed: 11/30/2022] Open
Abstract
Central venous catheter have become ubiquitous with greater than 15 million catheter days/year in the intensive care setting alone. However, the procedure carries with it several immediate and other delayed complications that can result in significant morbidity, mortality, and increased healthcare cost. We report a rare case of significantly delayed complications associated with intravascular loss of guide wire during central venous catheter placement and its impact on patient's long term management. The case highlights not only the importance of proper technique and safety precaution in performing an increasingly common procedure, but also the need for timely identification and rectification of medical errors, especially in the context of improved physician-patient communication.
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Affiliation(s)
- Hong Loan Nguyen
- Baylor College of Medicine, McNair Campus, 7200 Cambridge St., Suite 8B, Houston, TX, 77030, USA
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Rao R, Marshalleck FE, Ladd AP. Endovascular retrieval of difficult to remove port-a-caths. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2019. [DOI: 10.1016/j.epsc.2019.101248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Canyiğit M, Ateş ÖF, Sağlam MF, Hıdıroğlu M. Successful treatment of unexpected complication during aortic stent-grafting: retrieval of broken stent-graft tip by coaxial technique. ACTA ACUST UNITED AC 2019; 25:169-172. [PMID: 30774091 DOI: 10.5152/dir.2019.18263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Thoracic aortic endovascular repair (TEVAR) is increasingly preferred as a treatment of choice in thoracic aortic diseases. Intravascular foreign body is one of the TEVAR-related complications similar to the other endovascular operations. Here, to the our best knowledge for the first time in the English literature, this report presents an extremely rare complication of a broken and stuck tip part of aortic stent-graft in the intravascular space and successful removal by using the coaxial technique. Thoracic aortic endovascular repair (TEVAR) has been increasingly preferred as the treatment of choice in thoracic aortic diseases (1). Endovascular treatment has been gaining popularity compared with open surgery due to its less invasive approach and rapid application, and allows the patient to easily return to daily life (2). However, TEVAR is associated with several specific complications including paraplegia, stroke, vascular injuries and local complications. These complications depend on vascular or nonvascular comorbidities, vascular anatomy, equipment, and experience of the provider (3-6). Intravascular foreign body could be among TEVAR-related complications similar to other endovascular operations (7). Several types of equipment, including guidewire, vascular sheath, or suboptimally uncoiled stents may get stuck in the intravascular space, causing complications (8). Herein, to the best of our knowledge, we present the first report in the English literature of broken and stuck tip part of an aortic stent-graft in the intravascular space and its successful removal using the coaxial technique.
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Affiliation(s)
- Murat Canyiğit
- Departments of Radiology, Ankara Yıldırım Beyazıt University School of Medicine, Ankara, Turkey
| | - Ömer Faruk Ateş
- Department of Radiology, Ankara Training and Research Hospital, Ankara, Turkey
| | - Muhammet Fethi Sağlam
- Departments of Radiology, Ankara Yıldırım Beyazıt University School of Medicine, Ankara, Turkey
| | - Mete Hıdıroğlu
- Departments of Radiology, Ankara Yıldırım Beyazıt University School of Medicine, Ankara, Turkey
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Serrano OK, Stampe C, Rosenberg MS, Golzarian J, Kandaswamy R. Transjugular Removal of a Retained Intraportal Procurement Cannula in a Liver Transplant Recipient. J Vasc Interv Radiol 2018; 29:1778-1780. [PMID: 30502883 DOI: 10.1016/j.jvir.2018.07.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 07/14/2018] [Accepted: 07/20/2018] [Indexed: 10/27/2022] Open
Affiliation(s)
- Oscar K Serrano
- Division of Transplantation, Department of Surgery, University of Minnesota Medical School, Mayo Mail Code 195, 420 Delaware Street SE, Minneapolis, MN 55455
| | - Christopher Stampe
- Department of Radiology, University of Minnesota Medical School, Mayo Mail Code 195, 420 Delaware Street SE, Minneapolis, MN 55455
| | - Michael S Rosenberg
- Department of Radiology, University of Minnesota Medical School, Mayo Mail Code 195, 420 Delaware Street SE, Minneapolis, MN 55455
| | - Jafar Golzarian
- Department of Radiology, University of Minnesota Medical School, Mayo Mail Code 195, 420 Delaware Street SE, Minneapolis, MN 55455
| | - Raja Kandaswamy
- Division of Transplantation, Department of Surgery, University of Minnesota Medical School, Mayo Mail Code 195, 420 Delaware Street SE, Minneapolis, MN 55455
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Kass J, Sherkat A, Nahum E, Hartman M. Search and Rescue: A Case Report and Discussion of Iatrogenic Intravascular Foreign Bodies. Curr Probl Diagn Radiol 2018; 50:268-273. [PMID: 30121159 DOI: 10.1067/j.cpradiol.2018.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Accepted: 07/17/2018] [Indexed: 11/22/2022]
Abstract
The following case report demonstrates an unusual case of a patient with multiple intravascular iatrogenic foreign bodies. An inferior vena cava filter was identified in the abdominal aorta, and multiple hydrophilic wire fragments were found in the pulmonary circulation. After describing the management of this patient, we discuss how radiologists can best distinguish between various intravascular iatrogenic foreign bodies. Determining the type of catheter or wire within the patient can not only establish the chronicity of the finding, but can determine whether or not endovascular retrieval is recommended, and by what method. It is of the utmost importance that providers be able to distinguish between various intravascular devices in order to prevent ongoing or further harm to the patient.
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Affiliation(s)
- Jonathan Kass
- Department of Radiology, Allegheny General Hospital, Pittsburgh, PA.
| | - Amir Sherkat
- Department of Radiology, Allegheny General Hospital, Pittsburgh, PA; Department of Radiology, MedStar Georgetown University Hospital, Washington, DC.
| | - Elmer Nahum
- Department of Radiology, Allegheny General Hospital, Pittsburgh, PA.
| | - Matthew Hartman
- Department of Radiology, Allegheny General Hospital, Pittsburgh, PA
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Jambon E, Hocquelet A, Petitpierre F, Le Bras Y, Marcelin C, Dubuisson V, Grenier N, Cornelis F. Proximal embolization of splenic artery in acute trauma: Comparison between Penumbra occlusion device versus coils or Amplatzer vascular plug. Diagn Interv Imaging 2018; 99:801-808. [PMID: 29910169 DOI: 10.1016/j.diii.2018.05.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2018] [Revised: 04/14/2018] [Accepted: 05/16/2018] [Indexed: 11/29/2022]
Abstract
PURPOSE To compare intervention duration and fluoroscopy time for proximal embolization of splenic arteries in acute trauma using the Penumbra occlusion device (POD®), coils or Amplatzer™ vascular plug (AVP). MATERIAL AND METHODS A total of 29 patients with splenic injury without vascular injury who were treated by proximal splenic artery embolization using POD® (n=12), coils (n=9) or AVP (n=8) were retrospectively included. There were 25 men and 4 women with a median age of 34 years (range: 10-69 years). To overcome bias in treatment choice, a propensity score was used using inverse probability weighting. Intervention duration and fluoroscopy time, treatment success and complications were compared. RESULTS The median intervention duration was significantly shorter using POD® (30min) or AVP (47min) than using coils (60min) (P=0.0001 and 0.004, respectively). The median fluoroscopy time was significantly lower using POD® (11.5min) than using coils (23.6min) (P=0.0076) or AVP (16.5min) (P=0.049). The primary efficacy rate was 100% with POD® and AVP and 89% with coils (P=0.586). Six complications occurred with a mean follow-up of 12 months for POD®, 32 months for coils and 40 months for AVP, consisting in 2 abscesses treated by anti-biotherapy with POD®, one abscess with AVP, 2 material migrations with coils and 1 coil dismantled without consequence. CONCLUSION POD® and AVP allow proximal embolization of splenic artery in acute trauma with shorter intervention duration by comparison with conventional metallic coils with similar technical success. POD® allows a shorter fluoroscopy time than coils or AVP.
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Affiliation(s)
- E Jambon
- Department of Radiology, Pellegrin University Hospital Center, place Amélie Raba Léon, 33076 Bordeaux, France.
| | - A Hocquelet
- Department of Radiology, Haut-Leveque University Hospital Center, avenue Magellan, 33600 Pessac, France; Department of Radiology, University Hospital Center, 46, rue du Bugnon, 1011 Lausanne, Switzerland
| | - F Petitpierre
- Department of Radiology, Pellegrin University Hospital Center, place Amélie Raba Léon, 33076 Bordeaux, France
| | - Y Le Bras
- Department of Radiology, Pellegrin University Hospital Center, place Amélie Raba Léon, 33076 Bordeaux, France
| | - C Marcelin
- Department of Radiology, Pellegrin University Hospital Center, place Amélie Raba Léon, 33076 Bordeaux, France
| | - V Dubuisson
- Department of Surgery, Pellegrin Hospital, place Amélie Raba Léon, 33076 Bordeaux, France
| | - N Grenier
- Department of Radiology, Pellegrin University Hospital Center, place Amélie Raba Léon, 33076 Bordeaux, France
| | - F Cornelis
- Department of Radiology, Pellegrin University Hospital Center, place Amélie Raba Léon, 33076 Bordeaux, France; Department of Radiology, Tenon Hospital, AP-HP, 4, rue de la Chine, 75020 Paris, France
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Baltazares-Lipp ME, Sarabia-Ortega B, Soto-González JI, Aboitiz-Rivera CM, Carmona-Ruiz HA, Blachman-Braun R. Intravascular Foreign Bodies. Chin Med J (Engl) 2018; 131:484-485. [PMID: 29451156 PMCID: PMC5830836 DOI: 10.4103/0366-6999.225060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Herbert JT, Kertai MD. Transesophageal Echocardiography Use in Diagnosis and Management of Embolized Intravascular Foreign Bodies. Semin Cardiothorac Vasc Anesth 2018; 22:100-103. [PMID: 29327650 DOI: 10.1177/1089253217735912] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The increasing use of endovascular interventions coupled with the large number of published case series detailing complications attest to the likelihood that anesthesiologists will encounter a case of intravascular foreign body embolization during their careers. Transesophageal echocardiography is essential to the diagnosis and management of traumatic and intravascular foreign bodies embolized to the heart because it can identify not only the foreign body but also hemodynamically significant lesions to radiolucent anatomic structures prior to and during surgical exploration. In this case presentation, we review how intraoperative transesophageal echocardiography facilitated the intraoperative assessment and management of a post-liver transplant patient who underwent open surgical removal of migrated inferior vena cava stent from the right ventricle with concomitant tricuspid valve annuloplasty.
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Affiliation(s)
| | - Miklos David Kertai
- 1 Duke University Medical Center, Durham, NC, USA.,2 Vanderbilt University Medical Center, Nashville, TN, USA
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Whang G, Lekht I, Krane R, Peters G, Palmer SL. Unintentionally retained vascular devices: improving recognition and removal. Diagn Interv Radiol 2018; 23:238-244. [PMID: 28362267 DOI: 10.5152/dir.2017.16369] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The increased demand for minimally invasive placement of intravascular medical devices has led to increased procedure-related complications, including retention of all or part of the implanted device. A number of risk factors can predispose to unintentionally retained vascular devices (uRVD); most are technical in etiology. Despite best efforts to insert and remove vascular devices properly, uRVD still occur. Prevention or early identification of uRVD is ideal; however, procedural complications are not always recognized at the time of device insertion or removal. In these cases, early radiologic diagnosis is important to enable expeditious removal and reduction of morbidity, mortality, and medicolegal consequences. The diagnostic radiologist's role is to identify suspected uRVD and ensure proper communication of the findings to the referring clinician. The diagnostic radiologist can implement various strategies to increase detection of uRVD and advise the referring clinician regarding the use of minimally invasive percutaneous techniques for safe removal of uRVD.
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Affiliation(s)
- Gilbert Whang
- Department of Radiology, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA.
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44
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Kutzin JM. A 74-Year-Old Woman with A Visible Mass in Arm. J Emerg Nurs 2017; 44:409-410. [PMID: 28965645 DOI: 10.1016/j.jen.2017.08.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Revised: 08/18/2017] [Accepted: 08/26/2017] [Indexed: 11/16/2022]
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Bismuth J, Gray BH, Holden A, Metzger C, Panneton J. Pivotal Study of a Next-Generation Balloon-Expandable Stent-Graft for Treatment of Iliac Occlusive Disease. J Endovasc Ther 2017; 24:629-637. [DOI: 10.1177/1526602817720463] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Purpose: To evaluate the safety and efficacy of a next-generation balloon-expandable stent-graft for the treatment of arterial occlusive disease in patients with de novo or restenotic lesions in the common and/or external iliac arteries. Methods: A prospective, multicenter, single-arm safety and efficacy study ( ClinicalTrials.gov identifier: NCT02080871) of the VBX Stent Graft for treatment of de novo or restenotic lesions in the iliac arteries was conducted under an Investigational Device Exemption at 26 US sites and 1 New Zealand center. The study eligibility criteria were established with the aim of enrolling more “real-world” patients compared with previous iliac stent studies supporting Food and Drug Administration approval. The study enrolled 134 patients (mean age 66±9.5 years; 79 men) with 213 iliac lesions. Three-quarters of the population (101, 75.4%) had Rutherford category 3 ischemia, and 43 (32.1%) patients presented with TASC II C/D lesions. The primary endpoint was a composite of device- or procedure-related death within 30 days, myocardial infarction within 30 days, target lesion revascularization (TLR) within 9 months, and amputation above the metatarsals in the treated leg within 9 months. Results: In all, 234 devices were implanted in 213 lesions with 100% technical success; 57 (42.5%) patients received kissing stents at the aortic bifurcation. No devices exhibited a discernable change in length after final deployment as determined by independent core laboratory quantitative angiographic analysis. At 9 months, 3 (2.3%) of 132 patients (1 lost to follow-up, 1 unrelated death) experienced a major adverse event (3 TLRs) related to the primary endpoint. At 9 months, there were no device-related serious adverse events or unanticipated adverse device effects. Conclusion: The next-generation balloon-expandable stent-graft demonstrated notable 9-month safety and efficacy in treating iliac occlusive disease in patients reflecting common clinical practice.
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Affiliation(s)
- Jean Bismuth
- DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, TX, USA
| | - Bruce H. Gray
- University of South Carolina School of Medicine, Greenville, SC, USA
| | - Andrew Holden
- Auckland University School of Medicine, Auckland, New Zealand
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Endovascular stentectomy using the snare over stent-retriever (SOS) technique: An experimental feasibility study. PLoS One 2017; 12:e0178197. [PMID: 28542580 PMCID: PMC5444789 DOI: 10.1371/journal.pone.0178197] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2016] [Accepted: 05/08/2017] [Indexed: 11/19/2022] Open
Abstract
Feasibility of endovascular stentectomy using a snare over stent-retriever (SOS) technique was evaluated in a silicon flow model and an in vivo swine model. In vitro, stentectomy of different intracranial stents using the SOS technique was feasible in 22 out of 24 (92%) retrieval maneuvers. In vivo, stentectomy was successful in 10 out of 10 procedures (100%). In one case self-limiting vasospasm was observed angiographically as a technique related complication in the animal model. Endovascular stentectomy using the SOS technique is feasible in an experimental setting and may be transferred to a clinical scenario.
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Moore K, Khan NR, Michael LM, Arthur AS, Hoit D. Republished: Endovascular retrieval of dental needle retained in the internal carotid artery. J Neurointerv Surg 2017; 9:e26. [DOI: 10.1136/neurintsurg-2016-012771.rep] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/25/2016] [Indexed: 11/04/2022]
Abstract
Intravascular foreign bodies are a known complication of medical and dental procedures. Dental anesthetic needles may be broken off and retained in the oropharynx. These needles have occasionally been reported to migrate through the oral mucosa in to deeper structures. Here we present the case of a 57-year-old man who had a retained dental needle that had migrated into his internal carotid artery. The needle was removed using endovascular techniques. To our knowledge, this is the first report of a retained dental needle being retrieved using this method. We review the literature on intravascular foreign bodies, retained dental needles, and endovascular techniques for retrieval of such foreign bodies.
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Moore K, Khan NR, Michael LM, Arthur AS, Hoit D. Endovascular retrieval of dental needle retained in the internal carotid artery. BMJ Case Rep 2017; 2017:bcr-2016-012771. [PMID: 28274944 DOI: 10.1136/bcr-2016-012771] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Intravascular foreign bodies are a known complication of medical and dental procedures. Dental anesthetic needles may be broken off and retained in the oropharynx. These needles have occasionally been reported to migrate through the oral mucosa in to deeper structures. Here we present the case of a 57-year-old man who had a retained dental needle that had migrated into his internal carotid artery. The needle was removed using endovascular techniques. To our knowledge, this is the first report of a retained dental needle being retrieved using this method. We review the literature on intravascular foreign bodies, retained dental needles, and endovascular techniques for retrieval of such foreign bodies.
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Affiliation(s)
- Kenneth Moore
- University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Nickalus R Khan
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - L Madison Michael
- Semmes-Murphey Neurologic and Spine Institute, Memphis, Tennessee, USA
| | - Adam S Arthur
- UT Department of Neurosurgery/Semmes-Murphey Clinic, Memphis, Tennessee, USA
| | - Daniel Hoit
- Department of Neurosurgery, University of Tennessee, Memphis, Tennessee, USA
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Bompotis G, Karkanis G, Chatziavramidis A, Konstantinidis I, Dokopoulos P, Lazaridis I, Pyriochos P. Percutaneous Removal of a Tiny Needle Fracture From the Right Ventricle of the Heart in a Drug Abuser. Vasc Endovascular Surg 2017; 50:575-578. [PMID: 28081692 DOI: 10.1177/1538574416680979] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE To demonstrate the successful percutaneous removal of a tiny needle fracture from the heart with the use of a guide wire with a magnet at its distal end and two snares through both femoral veins. CASE REPORT We report a rare case of a tiny needle fracture in the apex of the right ventricle of the heart in a drug abuser after its migration from the neck through the lumen of the right internal jugular vein. The procedure of the percutaneous approach and removal of this tiny foreign body was extremely difficult and dangerous due to its location and tiny size. CONCLUSION This percutaneous technique for the removal of a tiny foreign body from the heart was proven to be both effective and safe for the patient, and it provides a good therapeutic option for removal of intracardiac foreign bodies.
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Affiliation(s)
- Georgios Bompotis
- 1 Department of Interventional Cardiology, Papageorgiou General Hospital, Thessaloniki, Greece
| | - Georgios Karkanis
- 2 Department of Otolaryngology, Papageorgiou General Hospital, Thessaloniki, Greece
| | | | | | - Petros Dokopoulos
- 1 Department of Interventional Cardiology, Papageorgiou General Hospital, Thessaloniki, Greece
| | - Ioannis Lazaridis
- 3 Department of Vascular Surgery, Papageorgiou General Hospital, Thessaloniki, Greece
| | - Panagiotis Pyriochos
- 2 Department of Otolaryngology, Papageorgiou General Hospital, Thessaloniki, Greece
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Jambon E, Petitpierre F, Brizzi V, Dubuisson V, Le Bras Y, Grenier N, Cornelis F. Proximal Occlusion of Medium-Sized Vessels with the Penumbra Occlusion Device: A Study of Safety and Efficacy. Cardiovasc Intervent Radiol 2016; 40:210-215. [PMID: 27921152 DOI: 10.1007/s00270-016-1480-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Accepted: 09/27/2016] [Indexed: 01/21/2023]
Abstract
PURPOSE To retrospectively investigate the safety and efficacy of hybrid proximal coiling of various medium-sized vessels (4 to 8 mm) using the Penumbra Occlusion Device (POD). MATERIALS AND METHODS From October 2014 to February 2016, 37 proximal embolizations were performed with PODs in 36 patients (mean age: 50.8, range: 10-86; 29 male, 7 female). Vessel occlusions were achieved under fluoroscopic guidance using a 2.7 French microcatheter. Among the 36 vessels targeted, 16 were splenic arteries, 11 renal arteries, 4 mesenteric arteries, 3 arteriovenous fistulae, 1 iliac artery, and 1 gonadal vein. Intermittent follow-up angiography was performed to assess the flow for final occlusion. Outcomes and complications were assessed by clinical and/or imaging follow-up. RESULTS To produce proximal occlusion of the intended vessels, the POD was used alone in 19 embolizations (51.4 %). In 12 procedures (32.4 %), POD was used as a coil constrainer to secure the coil construct. In 6 procedures (16.2 %), additional embolic devices were used to achieve vessel occlusion after initial POD deployment. After a mean follow-up of 3.2 months, no POD migration was observed but two complications occurred (5.4 %): one post embolic syndrome and one extensive infarction with splenic abscess. CONCLUSION The POD system allows safe and effective proximal embolization of medium-sized vessels in a variety of clinical settings.
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Affiliation(s)
- E Jambon
- Department of Radiology, Pellegrin Hospital, Place Amélie Raba Léon, 33076, Bordeaux, France
| | - F Petitpierre
- Department of Radiology, Pellegrin Hospital, Place Amélie Raba Léon, 33076, Bordeaux, France
| | - V Brizzi
- Department of Surgery, Pellegrin Hospital, Place Amélie Raba Léon, 33076, Bordeaux, France
| | - V Dubuisson
- Department of Surgery, Pellegrin Hospital, Place Amélie Raba Léon, 33076, Bordeaux, France
| | - Y Le Bras
- Department of Radiology, Pellegrin Hospital, Place Amélie Raba Léon, 33076, Bordeaux, France
| | - N Grenier
- Department of Radiology, Pellegrin Hospital, Place Amélie Raba Léon, 33076, Bordeaux, France
| | - F Cornelis
- Department of Radiology, Pellegrin Hospital, Place Amélie Raba Léon, 33076, Bordeaux, France.
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