Percutaneous retrieval of a chronic foreign body with both intravascular and extravascular components

Removal of unwanted intravascular foreign body is a useful but infrequent procedure carried out by interventional radiologists. We study a patient who had a long guidewire left in her body following central venous catheter placement by a surgeon. The guidewire was later found in situ, with both intravascular and extravascular components in continuity. We successfully removed the guidewire without causing any complications. Standard interventional techniques, Amplatz gooseneck snare (Microvena, White Bear Lake, MN, USA) and 6-Fr Multipurpose catheter were used.     

Percutaneous vascular foreign body retrieval: experience of an 11-year period

Over an 11-year period, percutaneous retrieval of intravascular foreign bodies was performed in 12 patients, using urological forceps and retrieval baskets. No clinically significant complication occurred, success rate was 100%. Review of 176 cases from the literature showed a success rate of 90%.     

Percutaneous retrieval of intravascular foreign bodies

INTRODUCTION: The spreading of interventional procedures and the frequent use and replacement of central venous catheters have contributed to a relative increase in the occurrence of intravascular foreign bodies (FBs). Their retrieval is justified by potential complications related to their characteristics, location and permanence. The high morbidity related to surgical retrieval, especially in case of intravenous FBs (often located in the right cardiac chambers or the pulmonary artery) has contributed to the spreading of interventional retrieval procedures. The purpose of percutaneous retrieval is: 1) to hook the FB to stop its migration to more critical districts; 2) to extract it through the percutaneous access route or, if the latter is unfeasible, 3) to simplify surgical retrieval. MATERIAL AND METHODS: We report our experience with 15 patients presenting an FB [intravenous (i.v.) in 11 cases and intra-arterial (i.a.), in 4]. Retrieval was performed mainly with snare-loop catheters (13 cases, together with a pig-tail catheter in 3 patients) and also with Dormia baskets (3 cases, together with a snare loop in 1 case). To ensure the percutaneous retrieval, we used introductors with a greater caliber than that of the FB, the latter generally being a 6-7 F intravenous catheter. The percutaneous approach was mostly transfemoral (right femoral in 9 cases and bilateral femoral, left femoral, axillary and left jugular in 1 case each). RESULTS: Percutaneous retrieval was successful in all the i.v. cases and in 1 ia case. The other 3 ia cases required surgical removal under local anesthesia after percutaneous hooking and displacement of the FB to a more accessible site. No major complications were observed during retrievals. CONCLUSIONS: Based on our personal results and in agreement with the major international reports, we believe that percutaneous retrieval should be considered the treatment of choice for FBs. The procedure success depends on an accurate diagnostic approach, good knowledge of materials and techniques and the operator's experience, as well as the possibility of an interdisciplinary collaboration of the interventional radiologist with the surgeon and anesthesist.     

Experience with new retrieval forceps for foreign body removal in the vascular, urinary, and biliary systems

A new type of foreign body retrieval forceps recently has become available. It consists of single- or multiple-tooth forceps mounted on a flexible stainless steel 0.038-inch shaft. The authors have successfully used this device in the vascular system (three cases), in the urinary tract (seven cases), and in the biliary system (two cases) without complications. Foreign bodies removed include a catheter fragment, angiographic guide wire, detachable balloon, stone retrieval basket, and various stents. All the procedures were performed quickly and without difficulty. For the authors, these forceps have become the first choice in many retrieval situations.     

经皮肺动脉异物介入取出一例

患者男,9岁,因"原发孔房间隔缺损性先天心脏病"行"原发孔房间隔缺损根治术",在手术结束前关胸拔22 G"下腔静脉插管"时发现其头端脱落,当时手术视野内、外未发现脱落头端,故考虑脱落于心血管内,极有可能进入肺动脉.当时因无法确定脱落位置,故未手术取出.术后患者情况稳定.为了尽快祛除异物,行胸部正位片检查后,发现在左肺中上野锁骨中线第6后肋与第三前肋交叉处可见"齿轮状"阴影.复行多层螺旋CT检查示:左肺上叶前段基底部异物影,与"下腔静脉插管"头端相似,通过重建显示发现异物头端近心(图1).结合手术病史,考虑"肺动脉内异物"的诊断.因手术取出有困难,故考虑先行"经股静脉肺动脉造影"以明确诊断,必要时用介入方法将异物取出.     

Percutaneous Transhepatic Release of an Impacted Lithotripter Basket and Its Fractured Traction Wire Using a Goose-Neck Snare: a Case Report

In a patient with a distal common bile duct stone, a fracture of the traction wire of the basket occurring during the performance of mechanical lithotripsy resulted in the impaction of the lithotripter basket with a stone. The impacted lithotripter basket combined with a fracture of the traction wire is a rare complication of endoscopic stone removal. We were able to pull the impacted basket using an Amplatz goose-neck snare inserted via the percutaneous transhepatic route, which resulted in the freeing of the entrapped stone into the dilated supra-ampullary bile duct. The fractured traction wire and basket could be safely removed by pulling the traction wire from the mouth. The present report is the first to describe the safe and effective use of an Amplatz goose-neck snare for the management of a lithotripter basket impacted with a stone and a fractured traction wire.     

Percutaneous removal of encapsulated foreign body from the peritoneum

A novel method of removal of a walled off foreign body in the peritoneum using the percutaneous nephroscope is presented.     

Snare retrieval of intracranial thrombus in patients with acute stroke

Intravenous or intraarterial thrombolysis of intracranial emboli is becoming an accepted clinical treatment modality for acute ischemic stroke, but not all emboli respond to the lytic drug regimens available today. If drug therapy fails, mechanical retrieval seems warranted. Four patients whose condition was resistant to intravenous and intraarterial thrombolytic drug treatment underwent at least partial clot removal with use of a snare, and almost immediate clinical improvement was noted. A fifth patient's clot was removed before lytic drugs were administered. All five patients, who presented with a sudden onset of stroke, were evaluated by arterial angiography; then, after a failed trial of intraarterial fibrinolytic drugs, they were treated by passing a 2- or 4-mm snare through a microcatheter. The snare wire was guided around the thrombus, gently brought back toward the microcatheter-but not into it-and the entire microcatheter and snare assembly was then removed. In four of the five cases, follow-up angiography performed immediately after the retrieval showed wider distal branches than normal. Follow-up computed tomography results were abnormal in all cases, showing hyperdense material in the territory that was previously ischemic. This hyperdensity subsided within 48 hours in all but one patient who developed small parenchymal hemorrhages; however, he remained asymptomatic. The snare device offers an additional or alternative therapy until completely effective thrombolytic agents become available. Although use of a snare is not ideal, device improvements should make the retrieval less technically challenging and more effective. There is a need for improved mechanical extraction devices, especially in light of the patient improvement that occurred. This experience also suggests that immediate removal of a mature clot could reduce the total time of brain ischemia more quickly than administration of thrombolytic drugs.     

DSA下排除胆道异物1例

患者女,79岁.因十二指肠壶腹痛,梗阻性黄疸,先行PTCD引流胆汁后手术切除十二指肠壶腹部肿瘤,行十二指肠乳头成形.术中在十二_二指肠乳头开口处留置一段直径约4mm长度约50mm塑料支撑管(裁截自输液器)支撑吻合口.     

Percutaneous transhepatic cholangioscopy-guided lithotripsy and retrieval of vascular coils eroded into the biliary tree

Endovascular coil erosion into the biliary system after hepatic artery embolization is a rare complication which may result in inflammation, strictures, choledocholithiasis, biliary colic, and cholangitis. Removal of coils may result in cessation of these symptoms, but is challenging in patients who cannot undergo removal via standard endoscopic approaches. This case report describes the retrieval of coils placed across a hepatic artery pseudoaneurysm, which over several years eroded into the biliary tree, resulting in calculi formation and post-prandial pain. Using combined fluoroscopy and cholangioscopy via percutaneous transhepatic accesses, the calculi were fragmented and the coils were retrieved, resulting in cessation of symptoms.     

上消化道异物内镜处置28例报告

上消化道异物可发生在任何年龄。发病原因多为误吞金属、塑料制品或食物残渣所致 ,或因动植物性及药物在上消化道内结块。较大而锐利者常可损伤消化道粘膜、血管 ,引起梗阻、穿孔或急性腹膜炎 ,甚至危及生命。经内镜取出异物是一种行之有效的紧急处理措施。1　临床资料1 1　本组 2 8例均为 2 0 0 0年就诊的病人 ,男 1 9例 ,女 9例 ;年龄在 1 2岁～ 68岁之间。异物种类分别为 :外源性异物 2 5例 ,其中有塑料药瓶盖、骨头刺、戒指、纪念币、果核、肉团、折叠剪刀 ;内源性异物 3例 ,为胃柿石、十二指肠蛔虫。分布部位 :食管 1 8例 ,胃 9例 ,十…     

Percutaneous ultrasound-guided cholangiography using microbubbles to evaluate the dilated biliary tract: initial experience

Objective  

To evaluate the feasibility of percutaneous ultrasound cholangiography (PUSC) with a microbubble contrast agent in assessing obstructive bile duct diseases.     

Pictorial essay: foreign body of the gastrointestinal tract in emergency radiology

The ingestion of a foreign body is a relatively common gastrointestinal emergency that causes significant morbidity. Radiological procedures play a very important role in revealing the presence, the location and the nature of an ingested foreign body, thus enabling the best therapeutic approach. We present the radiological features of common and uncommon foreign bodies ingested or with transanal insertion, differentiated on the basis of the location in the gastrointestinal tract. Diagnostic pitfalls are also considered.     

使用微泡对比剂进行超声引导下经皮胆道造影术评价胆道扩张程度:初步经验

目的评估使用微泡对比剂进行超声引导下经皮胆道造影术(PUSC)评定胆道阻塞性疾病的可行性。方法共58例梗阻性黄疸病人超声引导下经皮经肝胆道引流术(PTCD)后分别进行了PUSC和经皮肝穿刺胆道造影术     

Seed loss through the urinary tract and retrieval after prostate seed implant

This study describes our experience with seed loss and retrieval through the urinary tract following seed implants for prostate cancer, and offers Japanese guidelines for safety and management. Two hundred consecutive patients were analyzed. All patients were preplanned with a modified peripheral loading technique and implanted with a Mick applicator under ultrasound guidance. All patients were instructed to return excreted seeds, if any, to our center. Seed loss occurred in 6% of patients and 0.13% of seeds. Seed loss tended to occur in the early period through either urine or ejaculation.     

Percutaneous brush biopsy and internal drainage of biliary tree through endoprosthesis

Percutaneous insertion of a permanent internal prosthesis for biliary tract decompression was successful in 15 patients with obstructive jaundice. Percutaneous brush biopsy of the obstructing lesion that preceded stent placement in six patients was successful in obtaining diagnostic tissue in four. Both techniques are described in detail with illustrative cases.