Nitinol gooseneck snare for removal of foreign bodies: experimental study and clinical evaluation

The authors describe their use of a new right-angle snare made of nickel-titanium (nitinol) cable for retrieval of foreign bodies and iatrogenically placed devices. The snare loop is at right angles to the cable and comes in five sizes (5, 10, 15, 25, and 35 mm); its radiographic visualization is enhanced by gold-plated tungsten coils. This snare was used to retrieve wire and catheter fragments introduced into the thoracic vasculature of four dogs. Eleven of 13 attempts were successful. Three attempts to retrieve intravascular foreign bodies were successful in two patients; in one of these patients, a 10-mm snare was used to remove a fractured end of a ventriculoatrial shunt tube from the left pulmonary artery. In three other patients, four ureteral stents were successfully removed under fluoroscopic guidance. All retrievals were performed through a vascular sheath and with standard techniques and angiographic equipment. No complications were seen in any of the patients or dogs.     

Retrieval of intravascular foreign bodies with goose neck snare

PURPOSE: to evaluate the efficacy and advantages of the snare systems in the retrieval of foreign bodies from vascular system. MATERIALS AND METHODS: the snare technique has been used for intravascular foreign body retrieval. We performed percutaneous extraction of intravascular foreign bodies using combination multipurpose catheters and a nitinol snare loop. In this report, we evaluated the patients who had performed endovascular device reposition or foreign body retrieval from 1998 to 2001. RESULTS: foreign body retrieval was performed in 15 patients. The foreign bodies consisted of seven fractured port catheters, one sheath fragment, one embolization coil, four wire fragments, one pace-maker transducer and one dislocated endovascular stent. In no case were surgical procedures required, and no complications were encountered. CONCLUSION: the snare technique is a useful and a safe method as an alternative procedure to surgery. This technique is highly effective with low rate complications.     

Retrieval of intravascular foreign bodies with the snare and catheter capture technique.

The authors report two cases of retrieval of iatrogenically placed intravascular metallic foreign bodies: a guide wire in the abdominal aorta and a guide-wire fragment in the inferior vena cava. The foreign bodies were retrieved with use of a new approach described as the "snare and catheter capture technique." This technique is useful with guide wires that are too stiff to safely remove doubled over.     

Percutaneous removal of intravascular foreign bodies

Catheter and guidewire fragments left remaining in the cardiovascular system induce a high incidence of morbidity. Percutaneous removal of these fragments was attempted in 13 patients, with complete success in 10, partial success in two, and the fragment was extraluminal in one patient. Technique of foreign body removal and problems encountered are discussed.     

Evaluation of current techniques for nonsurgical removal of intravascular iatrogenic foreign bodies.

Intravascular embolization of polyethylene catheter fragments continues to occur, the majority from intravenous indwelling catheters. Sixty-nine nonsurgical retrievals of embolized fragments have been reported. The various recorded retrieval techniques are reviewed as well as their respective successes and limitations. Complications of snare techniques, unsuccessful retrieval attempts, and factors influencing the choice of local surgical removal versus snare techniques are discussed. The fate of patients from whom embolized catheter fragments were not removed is reviewed in depth. Our figures indicate a 71% incidence of death or serious complication, which is significantly higher than previously reported.     

Ingested foreign bodies: removal by magnet

Metallic foreign bodies ingested by eight patients (seven children) were removed from the upper gastrointestinal tract by means of a magnet inserted into the end of an orogastric tube. No patient required hospitalization, anesthesia, surgery, or subsequent radiography, and all patients remained asymptomatic. In no case did the foreign body uncouple from the orogastric tube-magnet arrangement during retrieval. The procedure is an alternative to endoscopic or surgical removal in some cases of metallic foreign body ingestion.     

Stereotactic removal of foreign bodies in the maxillofacial area

A technique is described for making it possible to localize any deep-seated radiopaque foreign body in the soft tissues and skeleton of the maxillofacial area. Using a stereotactic guide system, any point in the facial skeleton can be reached exactly, with precalculated precision, from any point outside the face. Thus, a foreign body can be exposed and subsequently removed by a surgical approach that gives minimal discomfort and carries low risk. The target probe serves the surgeon as a guide bar whilst the tissue is dissected. A precondition of successful stereotactic operations in the head and neck area is close cooperation between neurosurgeons and maxillofacial surgeons.     

Ultrasound-guided removal of foreign bodies: personal experience

Foreign bodies (FBs) retained in the soft tissues are a common reason for medical consultation, and usually consist of wooden or metal splinters or glass shards. Failure to remove foreign bodies is likely to give rise to acute or late complications, such as allergies, inflammation or infection, that may be severe. The surgical removal of an FB is invasive, costly and technically challenging. The procedure may fail in some cases and carries the risk of complications. Our study describes a technique for the ultrasound-guided removal of an FB, devised from our experience, and demonstrates its advantages over the standard surgical procedure. Sixty-two patients (43 males and 19 females aged from 9 to 65 years, median age 31 years) presented at our institution between October 2005 and June 2008 with suspected foreign bodies retained in the soft tissues of various body districts. Radiographic and/or ultrasound diagnosis was established by a radiologist expert in musculoskeletal sonography. The same radiologist helped by a nurse subsequently undertook the ultrasound-guided removal in the outpatient’s clinic according to the technique described in the paper. ATL 5000 and PHILIPS iu22 ultrasound systems were used with high-frequency linear-array probes, sterile material, local anaesthetic (lidocaine 2%), scapels and surgical forceps. Antibiotic prophylaxis with amoxicillin and clavulanic acid were prescribed to all patients for 7 days after the procedure. Ninety-five FBs (39 glass, 35 metal, 17 vegetable, 2 plastic, 2 stone) were successfully removed under ultrasound guidance in all patients and the procedure took between 15 and 30 min. No complications arose either during or after the procedure. Seventy-five skin incisions were made and the wounds closed with Steri-Strips in 73/75 cases, whereas skin sutures were used in 2/75 cases. No complications arose either during or after the procedure. Ultrasound-guided removal of an FB retained in the soft tissues is a good alternative to surgery as is its relatively straightforward, inexpensive, repeatable and carries a low risk of complications. In addition, failure to remove an FB does not preclude traditional surgical removal. The advantages of this real-time procedure and the use of small instruments minimize bleeding time and avoid injury to surrounding structures. Patient compliance is enhanced by the fact that the procedure has little or no aesthetic impact. These encouraging results suggest ultrasound-guided removal as a first-choice procedure for the extraction of foreign bodies.     

神经导航引导下头皮异物取出术围手术期护理

神经导航（neuro-navigation）已经逐步成为神经外科常规技术之一,应用的范围也逐步扩大[1-3].我院地处滇南边疆少数民族地区,以往当地没有开展神经导航手术.近几年随着神经外科的迅速发展,2006年我院引进史塞克神经导航系统,到2009年7月开展了神经导航下头皮异物取出术24例,为配合这一新技术的顺利进行,开展了以病人为中心的全程护理,使病人在围手术期与医务人员密切配合,取得了良好的临床效果.