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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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Kethidi N, Barsoum K, Shukla PA, Kumar A. Inferior vena cava filter retrievals using advanced techniques: a systematic review. Diagn Interv Radiol 2023; 29:500-508. [PMID: 36960630 PMCID: PMC10679615 DOI: 10.4274/dir.2022.22908] [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: 08/26/2021] [Accepted: 03/07/2022] [Indexed: 01/15/2023]
Abstract
This study aimed to assess the safety of complex inferior vena cava (IVC) filter retrieval techniques through a systematic review of published literature. Using PubMed, a systematic review was conducted in line with the 2020 Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines to identify articles published through April 2020 that reported on complex IVC filter retrieval techniques in >5 patients. Case reports, review papers, and studies that did not report on primary outcomes or variables of interest were excluded. Risk of bias was assessed using a modified Newcastle-Ottawa Quality Assessment scale. Pooled success and complication rates were calculated for the overall number of complex retrieval attempts as well as for each filter type and each complex retrieval method. Sixteen fair-quality and three good-quality studies met the inclusion criteria, with 758 patients (428 female) who had undergone 770 advanced retrieval attempts. The mean age of the patients was 46.5 ± 7.1 years (range: 14.1-90), and the mean dwell time was 602.5 ± 388.6 days (range: 5-7336). Regarding filters, 92.6% (702/758) were retrievable and 7.4% (56/758) were permanent. Indications for complex retrieval included the failure of standard retrieval (89.2%; 676/758) and tilting or embedding in the caval wall (53.8%; 408/758); 92.6% (713/770) of the advanced retrieval attempts were successful. The pooled success rate was 92.0% (602/654) for retrievable filters and 96.4% (53/55) for permanent filters (P = 0.422). Only 2.8% (21/758) of patients experienced major complications, and the major complication rate was not significantly associated with filter type (P = 0.183). Advanced techniques for IVC filter retrieval appear safe for the retrieval of retrievable filters and certain permanent filters, with a low short-term major complication rate. Further studies on complex retrieval techniques used to remove permanent filters should be conducted to clarify their safety with respect to filter type.
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Affiliation(s)
- Nikhit Kethidi
- Department of Radiology, Division of Vascular and Interventional Radiology, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Kyrollos Barsoum
- Department of Radiology, Division of Vascular and Interventional Radiology, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Pratik A. Shukla
- Department of Radiology, Division of Vascular and Interventional Radiology, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Abhishek Kumar
- Department of Radiology, Division of Vascular and Interventional Radiology, Rutgers New Jersey Medical School, Newark, NJ, USA
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Zhong A, Trerotola SO, Stavropoulos SW. Endobronchial Forceps Retrieval of Embedded Inferior Vena Cava Filters: Retrieval of 535 Filters at a Single Center. J Vasc Interv Radiol 2022; 34:529-533. [PMID: 36509239 DOI: 10.1016/j.jvir.2022.12.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 11/16/2022] [Accepted: 12/01/2022] [Indexed: 12/14/2022] Open
Abstract
PURPOSE To report results of 16 years of using the endobronchial forceps technique to remove embedded inferior vena cava (IVC) filters. MATERIALS AND METHODS Between January 2005 and June 2021, 534 patients (310 women and 224 men) with a mean age of 52 years (standard deviation [SD] ± 16 years) presented for complex filter retrieval of 535 tip- or strut-embedded IVC filters. Tip-embedded filters were diagnosed on rotational venography. Filters were considered strut-embedded if they were closed-cell filters with dwell times of >6 months. The filter was dissected from the IVC using rigid bronchoscopy forceps and removed through a vascular sheath. RESULTS The endobronchial forceps technique was successful in 530 of 537 retrieval attempts on an intention-to-treat basis (98.7%); a total of 530 filters were retrieved. There were 7 failures: (a) 5 failed retrieval attempts (2 that were retrieved successfully in subsequent procedures) and (b) 2 for which retrieval was not attempted. The mean filter dwell time was 1,459 days (SD ± 1,617 days). Laser sheaths were not used for any removal. Filters included herein were 137 Celect (94 Celect and 43 Celect Platinum), 99 Günther Tulip, 72 Option (48 Option and 24 Option Elite), 68 G2, 45 G2X/Eclipse, 42 Denali, 30 OptEase, 29 Recovery, 7 Meridian, and 6 ALN with Hook filters. Thirty-four minor (6.3%) and 11 major (2%) adverse events (AEs) occurred, which did not result in permanent sequelae. CONCLUSIONS Use of endobronchial forceps for removal of tip- and strut-embedded retrievable IVC filters is effective and has low AE rates.
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Affiliation(s)
- Anny Zhong
- Division of Interventional Radiology, Department of Radiology, Hospital of the University of Pennsylvania, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Scott O Trerotola
- Division of Interventional Radiology, Department of Radiology, Hospital of the University of Pennsylvania, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - S William Stavropoulos
- Division of Interventional Radiology, Department of Radiology, Hospital of the University of Pennsylvania, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
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Yao S, Li Y, Zhu F, Guan S, Ge X, Ci H. Biopsy Forceps-Assisted Loop Snare Technique for Complex Retrieval of Inferior Vena Cava Filter. Vasc Endovascular Surg 2022; 56:424-427. [PMID: 35171744 DOI: 10.1177/15385744211069052] [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: 11/15/2022]
Abstract
Severe tilt with embedded hooks is a common obstacle to successful inferior vena cava (IVC) filter retrieval. We present a case for which the biopsy forceps-assisted loop snare technique was successfully used to retrieve filters with hooks embedded in the IVC wall for which conventional retrieval failed. The technique is effective and provides a less-invasive, low-cost method for the complex retrieval of IVC filters.
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Affiliation(s)
- Sicheng Yao
- Division of Vascular Surgery, 159426People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, People's Republic of China
| | - Yangyang Li
- Division of Vascular Surgery, 159426People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, People's Republic of China
| | - Feng Zhu
- Division of Vascular Surgery, 159426People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, People's Republic of China
| | - Sheng Guan
- Division of Vascular Surgery, 159426People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, People's Republic of China
| | - Xiaohu Ge
- Division of Vascular Surgery, 159426People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, People's Republic of China
| | - Hongbo Ci
- Division of Vascular Surgery, 159426People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, People's Republic of China
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Quencer KB, Smith TA, Deipolyi A, Mojibian H, Ayyagari R, Latich I, Ali R. Procedural complications of inferior vena cava filter retrieval, an illustrated review. CVIR Endovasc 2020; 3:23. [PMID: 32337618 PMCID: PMC7184068 DOI: 10.1186/s42155-020-00113-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Accepted: 03/03/2020] [Indexed: 11/10/2022] Open
Abstract
Annually, approximately 65,000 inferior vena cava (IVC) filters are placed in the United States (Ahmed et al., J Am Coll Radiol 15:1553-1557, 2018). Approximately 35% of filters are eventually retrieved (Angel et al., J Vasc Interv Radiol 22: 1522-1530 e1523, 2011). Complications during filter retrieval depend heavily on technique and filter position. In this paper, we review risk factors and incidence of complications during IVC filter removal. We also discuss ways these complications could be avoided and the appropriate management if they occur.
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Affiliation(s)
- Keith B Quencer
- Division of Interventional Radiology, Department of Radiology, University of Utah, 50 N Medical Drive, Salt Lake City, UT, 84132, USA.
| | - Tyler A Smith
- Division of Interventional Radiology, Department of Radiology, University of Utah, 50 N Medical Drive, Salt Lake City, UT, 84132, USA
| | - Amy Deipolyi
- Division of Interventional Radiology, Department of Radiology, Memorial Sloan Kettering, New York, USA
| | - Hamid Mojibian
- Division of Interventional Radiology, Department of Radiology, Yale University, New Haven, USA
| | - Raj Ayyagari
- Division of Interventional Radiology, Department of Radiology, Yale University, New Haven, USA
| | - Igor Latich
- Division of Interventional Radiology, Department of Radiology, Yale University, New Haven, USA
| | - Rahmat Ali
- Division of Interventional Radiology, Department of Radiology, Yale University, New Haven, USA
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Forceps-assisted Removal of Difficult-to-Retrieve Filters: Preliminary Results. Ann Vasc Surg 2019; 61:371-376. [PMID: 31394218 DOI: 10.1016/j.avsg.2019.05.045] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 05/09/2019] [Accepted: 05/22/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND The aim of this study is to retrospectively evaluate the safety and effectiveness of forceps-assisted removal of difficult-to-retrieve filters. METHODS Patients who underwent forceps-assisted removal of difficult-to-retrieve filters (filters that could not be successfully removed with the standard loop-snare technique) between February 2008 and February 2019 were included in this study. Patients underwent forceps-assisted filter removal either immediately after failed loop-snare removal (same procedure) or at a later time (separate procedure). Data regarding success rate, X-ray exposure time, and complications were recorded. RESULTS A total of 27 patients (14 men, 13 women; mean age 57.9 ± 12.6 years) were included in this study. The mean indwelling time of the filters was 10.9 ± 10.7 months. All filters were successfully removed. The mean X-ray exposure time was 25.9 ± 12.7 min (range 8-55) for all patients; the mean X-ray exposure times were 10.2 ± 2.3 min (range 8-14) for the 5 patients who underwent forceps-assisted filter removal in a separate procedure and 29.5 ± 11.2 min (range 15-55) for the 22 patients who underwent forceps-assisted filter removal immediately after failure of the loop-snare technique (P < 0.001). Two patients (8.3%) experienced extravasation of contrast material and needed no additional treatment. No major complications occurred. CONCLUSIONS Forceps-assisted filter retrieval can be used to safely and effectively remove difficult-to-retrieve filters.
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