Intravascular Foreign body retrieval

Intravascular foreign body retrieval is a procedure used to remove objects inadvertently introduced into the vascular system. These objects can include catheter fragments, guidewires, stents, embolic coils, and other medical devices. The procedure is critical to prevent complications such as infection, embolism, vessel injury, or obstruction.

Indications for Intravascular Foreign Body Retrieval

• Fragmented Catheters: Broken pieces of catheters left within the vasculature.
• Lost Guidewires: Guidewires that have become detached or entrapped during procedures.
• Dislodged Stents or Coils: Devices that have migrated from their intended position.
• Embolic Materials: Particles that have embolized during procedures such as angioplasty or stent placement.
• Non-medical Objects: Foreign bodies that entered the vasculature through trauma or ingestion.

Techniques and Devices for Retrieval

1. Snare Devices:
   • Mechanism: Snare devices use a loop or lasso to capture and retrieve the foreign body.
   • Procedure:
     • Access: Typically via the femoral or radial artery/vein.
     • Navigation: A guidewire and catheter are navigated to the location of the foreign body.
     • Capture: The snare device is deployed to encircle and secure the foreign object.
     • Extraction: The foreign body is pulled back into the sheath or catheter and removed from the body.
   • Devices: Gooseneck® Snare, EN Snare®.
2. Forceps:
   • Mechanism: Endovascular forceps are used to grasp and retrieve foreign bodies.
   • Procedure:
     • Access and Navigation: Similar to snare device use.
     • Capture: The forceps are used to grip the foreign body securely.
     • Extraction: The object is carefully withdrawn through the vascular access site.
   • Devices: Various micro-forceps are available for different vessel sizes.
3. Aspiration Catheters:
   • Mechanism: Aspiration catheters use suction to retrieve small, embolic foreign bodies.
   • Procedure:
     • Access: Typically through a large-bore sheath.
     • Navigation: The catheter is advanced to the site of the foreign body.
     • Aspiration: Suction is applied to draw the foreign body into the catheter.
     • Extraction: The catheter containing the foreign body is withdrawn.
   • Devices: Penumbra® Aspiration System.
4. Basket Retrieval Devices:
   • Mechanism: These devices use a mesh basket to capture and retrieve foreign bodies.
   • Procedure:
     • Access and Navigation: Standard endovascular techniques.
     • Capture: The basket is deployed to encircle and trap the foreign object.
     • Extraction: The basket and the entrapped object are retracted through the access sheath.
   • Devices: Retriever baskets like the Amplatz Goose Neck® Snare.
5. Magnet-tipped Catheters:

• • Mechanism: Used to retrieve ferromagnetic foreign bodies.
  • Procedure:
    • Access and Navigation: As with other retrieval techniques.
    • Capture: The magnet at the tip of the catheter attaches to the foreign body.
    • Extraction: The magnetized foreign body is pulled back through the access site.
  • Devices: Specialized magnet-tipped catheters.

Procedure Steps

1. Pre-procedure Planning:
   • Imaging: Use of fluoroscopy, ultrasound, or CT to locate the foreign body.
   • Preparation: Ensure all necessary retrieval devices and backup options are available.
2. Access Site Preparation:
   • Vascular Access: Establish access through the femoral, radial, or jugular veins/arteries, depending on the location of the foreign body.
   • Sheath Insertion: Placement of an appropriate-sized sheath for device introduction.
3. Navigation to Foreign Body:
   • Guidewire and Catheter Navigation: Advance a guidewire to the foreign body’s location under imaging guidance.
   • Deployment of Retrieval Device: Introduce the chosen retrieval device (snare, forceps, basket, etc.) through the catheter.
4. Foreign Body Capture:
   • Manipulation and Capture: Use fluoroscopy to maneuver the retrieval device to capture the foreign body securely.
   • Confirmation: Confirm capture and securement of the foreign body before attempting extraction.
5. Extraction:
   • Controlled Removal: Slowly and carefully withdraw the device and the foreign body through the vascular sheath.
   • Post-extraction Imaging: Perform imaging to ensure complete removal and check for any remaining fragments or complications.
6. Post-procedure Care:
   • Hemostasis: Achieve hemostasis at the access site using manual compression or closure devices.
   • Monitoring: Observe the patient for any immediate complications, such as bleeding or vascular injury.
   • Follow-up: Regular follow-up to monitor for delayed complications like infection or embolism.

Potential Complications

• Vascular injury (dissection, perforation).
• Embolization of the foreign body or device fragments.
• Infection.
• Hematoma or bleeding at the access site.
• Retained foreign body fragments.

Management

• Immediate imaging to assess and address any complications.
• Surgical intervention if endovascular retrieval is unsuccessful or complications arise.
• Antibiotic therapy if infection is suspected.

Conclusion

Intravascular foreign body retrieval is a vital procedure in interventional radiology and cardiology, utilizing various devices and techniques tailored to the type and location of the foreign body. Successful retrieval requires careful planning, skilled navigation, and precise execution to minimize complications and ensure patient safety. Regular follow-up and monitoring are essential to detect and manage any delayed adverse events.