Effectiveness of hemostasis with Foley catheter after vacuum-assisted breast biopsy

Background

Interventional bleeding and post-interventional hematoma are the most common complications following vacuum-assisted breast biopsy (VABB). The aim of the current study was to evaluate the effectiveness of Foley catheter-induced hemostasis in VABB.

Methods

A randomized prospective controlled trial was conducted using a total of 437 consecutive 8-gauge ultrasound-guided VABB procedures that were performed in 282 patients from June 2012 to October 2013. In each procedure, hemostasis was induced with either a Foley catheter or with external compression. Bleeding during intervention, hematoma post-intervention and the time of procedure were recorded. Statistical analysis included a Chi-Square test and an independent-samples t-test, and P value <0.05 was considered to be significant.

Results

Significantly less bleeding and post-interventional hematoma resulted when hemostasis was induced using a Foley catheter vs. compression (7.6% vs. 17.4%, P=0.002; 8.9% vs. 27.9%, P<0.001). The mean time of breast biopsy was significantly less when using a Foley catheter vs. compression (33.6 vs. 45.5 min, P<0.001). No post-procedural infectious was encountered. In stratification analysis, there were no significantly different bleeding rates between the Foley catheter and compression methods in cases of single lesions (6.7% vs. 14.1%, P=0.346). In cases of multiple lesions, the Foley catheter method produced less bleeding/hematoma than compression (10.4% vs. 47.4%, P=0.018; 16.7% vs. 52.6%, P=0.020). Whether using a Foley catheter or compression to induce hemostasis, no significant difference was found in the rate of bleeding or hematoma when lesions <15 mm were removed (3.8% vs. 6.1%, P=0.531; 6.1% vs. 11.4%, P=0.340). When lesions ≥15 mm were excised, the rates of interventional bleeding and post-interventional hematoma were significantly lower in the Foley catheter study group than the compression control group (12.5% vs. 32.2%, P=0.034; 12.5% vs. 49.4%, P<0.001). There was significantly less bleeding (P=0.004) and hematoma (P<0.001) in the upper external quadrant when using a Foley catheter compared with compression (4.5% vs. 15.7%, P=0.004; 9.8% vs. 40.2%, P<0.001), but no significant differences for other quadrants.

Conclusions

Inducing hemostasis with a Foley catheter after VABB is a very effective and safe alternative to hemostasis with compression.     

Retrieval of “old” foreign bodies from the cardiovascular system in children

Several techniques have been developed to retrieve catheter and guide wire fragments that have embolized to the heart and pulmonary vasculature. In most instances, retrieval of the embolized fragments is performed soon after the event has occurred. In this report, we summarize our experience with the removal of these fragments in 3 children after a significant amount of time had elapsed since the time of embolization. The embolized catheter and guide wire fragments were removed without any complications. We also describe the techniques used for their removal, and the problems encountered during the removal of these “old” foreign bodies. Cathet. Cardiovasc. Diagn. 44:212–216, 1998. © 1998 Wiley-Liss, Inc.     

Endoscopic management of impacted esophageal foreign bodies

There are many reports on the endoscopic management of ingested foreign bodies in the upper gastrointestinal tract, however, little is known about the management of a specific subset of esophageal foreign bodies – impacted esophageal foreign bodies (IEFBs), especially perforating esophageal foreign bodies (PEFBs). The aim of this retrospective study on 78 cases was to report experience and outcome in the endoscopic management of the IEFBs in Chinese patients. From January 2006 to July 2011, a total of 750 patients with suspected upper gastrointestinal foreign bodies were admitted to the endoscopy center. Among these 750 patients, 78 cases that met the defined criteria of IEFBs were retrospectively enrolled in the present study, including 12 cases (12/78, 15.4%) with PEFBs. The major types of IEFBs were poultry bones (35.9%) and fish bones (17.9%). Most of the IEFBs (80.8%) were located in the upper esophagus, as were two thirds (66.7%) of the PEFBs. Foreign‐body retrieval forceps were the most frequently used accessory devices. Extraction of IEFBs failed in eight patients (10.3%) during the endoscopic procedure. The difficult points in endoscopic management were PEFBs, IEFBs with sharp points, and those with impaction for more than 24 hours. IEFBs should be treated as early as possible, and their endoscopic management is safe and effective. Endoscopic management is the first choice for PEFBs when the duration of impaction is less than 24 hours and there are no abscesses outside of the esophageal tract as determined by a computed tomography scan.     

UNUSUAL FOREIGN BODY: ESOPHAGEAL IMPACTION AFTER CYANOACRYLATE INJECTION FOR GASTRIC VARICES

Cyanoacrylate injection has been found in large series to be a remarkably safe and efficient treatment of gastric variceal bleeding. Dysphagia is a common local side‐effect of endoscopic intravariceal histoacryl injection. A 49‐year‐old woman with diagnosis of cirrhosis and portal hypertension related to hepatitis B virus infection was admitted to the Ibni Sina hospital due to dysphagia that started after injection of N‐butyl‐2‐cyanoacrylate (histoacryl) for gastric varices. She had undergone endoscopic gastric intravariceal histoacryl injection 2 years previously and again 1 month before the admission. There were no complications related to injection of the histoacryl or the endoscopy procedure itself. Dysphagia started immediately after the second endoscopy and was refractory to prokinetic and analgesic medication. She did not have any other complaint of medical significance. A diagnostic endoscopy revealed a heterogeneous foreign body stuck in the distal esophagus. Dysphagia resolved after endoscopic removal of the foreign body by endoscopic biopsy forceps. The heterogeneous material, which was mixed with food particles and tissue debris, was analyzed via infrared spectrophotometer and was found to be cyanoacrylate glue. In the present case, extrusion of the glue occurred earlier then expected and retching or vomiting might have dislodged the extruded glue from the stomach to the esophagus. If prolonged and intractable dysphagia starts after the endoscopy procedure, impaction of glue to the esophagus should be considered.     

The use of pigtail catheters for retrieval of foreign bodies from the cardiovascular system

Snare retrieval of foreign bodies is a common procedure but in certain cases, location of the foreign body requires another system. We present three cases in which only the use of a pigtail catheter gave a good grip for gentle traction and removal or repositioning of the foreign body. A careful review of the world literature up to December 1982 gave rise to two previous similar reports. Both our experience and that found in the literature seem to suggest that in cases where there are no free ends to snare, pigtail catheters may be the first instrument used to start retrieval.     

Endovascular clamping of porcelain aorta in aortic valve surgery using Foley Catheter

Unclampable calcified aorta is an uncommon condition that all cardiac surgeons may encounter and performing aortic valve surgery in this condition with a non cross-clamping technique of using Foley Catheter has rarely been reported. Aortic valve surgery invariably becomes a high-risk, challenging procedure to cardiac surgeon or even a contraindication to surgery when the ascending aorta cannot be clamped due to extensive calcification precluding safe dissection and clamping. We describe and recommend a non cross-clamping technique of using Foley Catheter and report it successful use in two patients who underwent aortic valve replacement with "porcelain" unclampable aorta.     

Western view of the management of gastroesophageal foreign bodies

The best modality for foreign body removal has beenthe subject of much controversy over the years.We have read with great interest the recent article by Souza Aguiar Municipal Hospital,Rio de Janeiro,Brazil,describing their experience with the management of esophageal foreign bodies in children.Non-endoscopic methods of removing foreign bodies(such as a Foley catheter guided or not by fluoroscopy)have been successfully used at this center.These methods could be an attractive option because of the following advantages:Shorter hospitalization time;easy to perform;no need for anesthesia;avoids esophagoscopy;and lower costs.However,the complications of these procedures can be severe and potentially fatal if not performed correctly,such as bronchoaspiration,perforation,and acute airway obstruction.In addition,it has some disadvantages,such as the inability to directly view the esophagus and the inability to always retrieve foreign bodies.Therefore,in Western countries clinical practice usually recommends endoscopic removal of foreign bodies under direct vision and with airway protection whenever possible.     

Endocardite por Burkholderia cepacia e corpo estranho intracardíaco

The authors describe the case of a renal transplant patient who developed late infective endocarditis associated with an intracardiac fragment of a catheter inserted 16 years before. Clinical presentation was anemia of undetermined cause and weight loss. Three blood cultures were positive for Burkholderia cepacia. Transesophageal echocardiography revealed a foreign body in the right atrium and right ventricle, confirmed by computed tomography. The patient underwent intravenous antibiotic therapy, followed by cardiac surgery to remove the foreign body. There were no postoperative complications, with improvement of anemia and stabilization of renal function.     

Percutaneous retrieval of a broken silastic catheter from the left atrium in a critically ill premature infant

A critically ill premature neonate (birthweight 1,395 g, gestational age 30 wk) had a broken silastic catheter lodged in the left atrium. We successfully retrieved the foreign body by percutaneous approach using a helical basket catheter under echocardiographic control. Such a therapeutical option for a broken, lightly radiopaque catheter has not been previously described in very low birthweight, critically ill infants. Cathet. Cardiovasc. Diagn. 42:409–411, 1997. © 1997 Wiley-Liss, Inc.     

Temporal stability of the location of the esophagus in patients undergoing a repeat left atrial ablation procedure for atrial fibrillation or flutter

Background: The esophagus may be mobile during a left atrial (LA) ablation procedure for atrial fibrillation (AF).
Objective: The goal of the study was to determine whether the location of the esophagus is stable in patients undergoing a repeat LA ablation procedure.
Methods: Forty-two patients underwent repeat LA ablation a mean of 7 ± 2 months after the initial procedure. Cinefluoroscopic images of the esophagus during a barium swallow were recorded and the course of the esophagus was tagged on the 3D map. The position of the esophagus at the index and repeat procedure were compared.
Results: At the index procedure, the esophagus was located near the left pulmonary veins (PVs) in 20 (48%), right PVs in 13 (31%), and at the mid LA in 9 (21%) patients. During the repeat procedure, the esophagus was found to be near the left PVs in 22 (52%), right PVs in 11 (26%), and at the mid LA in 9 patients (21%). In 35 of the 42 patients (83%), there was no change in the esophageal location, and in the remaining seven patients (17%), its position had shifted by ≥1 cm (range 1.0–4.0 cm).
Conclusions: In more than 80% of patients presenting for a repeat LA ablation procedure, the esophagus is in the same position relative to the PVs as during the initial procedure. Therefore, if radiofrequency ablation at a particular location was limited by the position of the esophagus, safe ablation at that site is unlikely to be feasible during a repeat procedure.     

Percutaneous retrieval of a broken umbilical catheter from left atrium in a premature newborn

A 30-week gestational age baby boy weighing 1,117 g born with cesarian section had a broken umbilical vein catheter lodged in the left superior pulmonary vein. We successfully retrieved the foreign body by percutaneous approach using a pigtail catheter and a snare wire under portable fluoroscopy. © 1995 Wiley-Liss, Inc.