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Tubular foreign body or stent: safe retrieval or repositioning using the coaxial snare technique.

Seong CK, Kim YJ, Chung JW, Kim SH, Han JK, Kim HB, Park JH - Korean J Radiol (2002 Jan-Mar)

Bottom Line: In all cases, it was possible to retrieve or reposition the various items, using a minimum-sized introducer sheath or a tract.No folding was involved.In no case were surgical procedures required, and no complications were encountered.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Kyungpook National University School of Medicine, Daegu, Korea.

ABSTRACT

Objective: To evaluate the utility and advantages of the coaxial snare technique in the retrieval of tubular foreign bodies.

Materials and methods: Using the coaxial snare technique, we attempted to retrieve tubular foreign bodies present in seven patients. The bodies were either stents which were malpositioned or had migrated from their correct position in the vascular system (n=2), a fragmented venous introducer sheath (n=1), fragmented drainage catheters in the biliary tree (n=2), or fractured external drainage catheters in the urinary tract (n=2). After passing a guidewire and/or a dilator through the lumina of these foreign bodies, we introduced a loop snare over the guidewire or dilator, thus capturing and retrieving them.

Results: In all cases, it was possible to retrieve or reposition the various items, using a minimum-sized introducer sheath or a tract. No folding was involved. In no case were surgical procedures required, and no complications were encountered.

Conclusion: The coaxial snare technique, an application of the loop snare technique, is a useful and safe method for the retrieval of tubular foreign bodies, and one which involves minimal injury to the patient.

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Related in: MedlinePlus

Ex-vivo study of the retrieval of a large-bore sheath fragment (8-F internal diameter and 10-F outer diameter) using a modified coaxial snare technique.A. In the large-bore fragmented vascular sheath, the simple coaxial snare technique does not allow engagement between the fragment and the 10-F or 12-F introducer sheath. The overall profile of the coaxial retrieval system is more than 14-F, with a shoulder between the 10-F introducer sheath (black arrow) and the sheath fragment (white arrows).B. The loop snare introduced through the smaller sheath (10-F) captures the fractured vascular sheath. Separate access is obtained via the larger sheath (12-F), and the central lumen of the fractured sheath is located with an angiographic catheter and guidewire.C. After engaging a dilator (small black arrow) at its end, the fragmented sheath (white arrow) is seen to be smoothly aligned with the introducer sheath (large black arrow).
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Figure 3: Ex-vivo study of the retrieval of a large-bore sheath fragment (8-F internal diameter and 10-F outer diameter) using a modified coaxial snare technique.A. In the large-bore fragmented vascular sheath, the simple coaxial snare technique does not allow engagement between the fragment and the 10-F or 12-F introducer sheath. The overall profile of the coaxial retrieval system is more than 14-F, with a shoulder between the 10-F introducer sheath (black arrow) and the sheath fragment (white arrows).B. The loop snare introduced through the smaller sheath (10-F) captures the fractured vascular sheath. Separate access is obtained via the larger sheath (12-F), and the central lumen of the fractured sheath is located with an angiographic catheter and guidewire.C. After engaging a dilator (small black arrow) at its end, the fragmented sheath (white arrow) is seen to be smoothly aligned with the introducer sheath (large black arrow).

Mentions: Simple snaring of a stent and catheter fragment resulted in the formation of a right angle between them and the snare axis (Figs. 1A, 2A). Owing to this angulation problem, it was necessary to fold the foreign objects prior to their retrieval by means of a simple snare technique; consequently, a much larger sheath was required for their extraction. In contrast, the coaxial snare technique greatly reduced the angle between the foreign objects and the snare axis, and allowed safe and smooth engagement between them and the sheath (Figs. 1B, 2B, 2C). Where a larger-bore venous sheath fragment was used, however, the extent to which the angle was reduced was insufficient to permit retrieval through the sheath (Fig. 3A). Although a larger-bore sheath can solve the problem, it carries the risk of vascular injury. As a variant of the coaxial snare technique, we used two access routes, the shorter one for a loop snare and the longer one for the retrieval of the sheath fragment. After capturing the fragment with a loop snare, an angiographic catheter and guidewire were used to locate its central lumen (Fig. 3B). In order to eliminate the shoulder between the guidewire and the fragment , and to facilitate smooth extraction, a dilator was then introduced through the sheath over the guidewire, and was tightly engaged with the end of the fragment (Fig. 3C).


Tubular foreign body or stent: safe retrieval or repositioning using the coaxial snare technique.

Seong CK, Kim YJ, Chung JW, Kim SH, Han JK, Kim HB, Park JH - Korean J Radiol (2002 Jan-Mar)

Ex-vivo study of the retrieval of a large-bore sheath fragment (8-F internal diameter and 10-F outer diameter) using a modified coaxial snare technique.A. In the large-bore fragmented vascular sheath, the simple coaxial snare technique does not allow engagement between the fragment and the 10-F or 12-F introducer sheath. The overall profile of the coaxial retrieval system is more than 14-F, with a shoulder between the 10-F introducer sheath (black arrow) and the sheath fragment (white arrows).B. The loop snare introduced through the smaller sheath (10-F) captures the fractured vascular sheath. Separate access is obtained via the larger sheath (12-F), and the central lumen of the fractured sheath is located with an angiographic catheter and guidewire.C. After engaging a dilator (small black arrow) at its end, the fragmented sheath (white arrow) is seen to be smoothly aligned with the introducer sheath (large black arrow).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2713984&req=5

Figure 3: Ex-vivo study of the retrieval of a large-bore sheath fragment (8-F internal diameter and 10-F outer diameter) using a modified coaxial snare technique.A. In the large-bore fragmented vascular sheath, the simple coaxial snare technique does not allow engagement between the fragment and the 10-F or 12-F introducer sheath. The overall profile of the coaxial retrieval system is more than 14-F, with a shoulder between the 10-F introducer sheath (black arrow) and the sheath fragment (white arrows).B. The loop snare introduced through the smaller sheath (10-F) captures the fractured vascular sheath. Separate access is obtained via the larger sheath (12-F), and the central lumen of the fractured sheath is located with an angiographic catheter and guidewire.C. After engaging a dilator (small black arrow) at its end, the fragmented sheath (white arrow) is seen to be smoothly aligned with the introducer sheath (large black arrow).
Mentions: Simple snaring of a stent and catheter fragment resulted in the formation of a right angle between them and the snare axis (Figs. 1A, 2A). Owing to this angulation problem, it was necessary to fold the foreign objects prior to their retrieval by means of a simple snare technique; consequently, a much larger sheath was required for their extraction. In contrast, the coaxial snare technique greatly reduced the angle between the foreign objects and the snare axis, and allowed safe and smooth engagement between them and the sheath (Figs. 1B, 2B, 2C). Where a larger-bore venous sheath fragment was used, however, the extent to which the angle was reduced was insufficient to permit retrieval through the sheath (Fig. 3A). Although a larger-bore sheath can solve the problem, it carries the risk of vascular injury. As a variant of the coaxial snare technique, we used two access routes, the shorter one for a loop snare and the longer one for the retrieval of the sheath fragment. After capturing the fragment with a loop snare, an angiographic catheter and guidewire were used to locate its central lumen (Fig. 3B). In order to eliminate the shoulder between the guidewire and the fragment , and to facilitate smooth extraction, a dilator was then introduced through the sheath over the guidewire, and was tightly engaged with the end of the fragment (Fig. 3C).

Bottom Line: In all cases, it was possible to retrieve or reposition the various items, using a minimum-sized introducer sheath or a tract.No folding was involved.In no case were surgical procedures required, and no complications were encountered.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Kyungpook National University School of Medicine, Daegu, Korea.

ABSTRACT

Objective: To evaluate the utility and advantages of the coaxial snare technique in the retrieval of tubular foreign bodies.

Materials and methods: Using the coaxial snare technique, we attempted to retrieve tubular foreign bodies present in seven patients. The bodies were either stents which were malpositioned or had migrated from their correct position in the vascular system (n=2), a fragmented venous introducer sheath (n=1), fragmented drainage catheters in the biliary tree (n=2), or fractured external drainage catheters in the urinary tract (n=2). After passing a guidewire and/or a dilator through the lumina of these foreign bodies, we introduced a loop snare over the guidewire or dilator, thus capturing and retrieving them.

Results: In all cases, it was possible to retrieve or reposition the various items, using a minimum-sized introducer sheath or a tract. No folding was involved. In no case were surgical procedures required, and no complications were encountered.

Conclusion: The coaxial snare technique, an application of the loop snare technique, is a useful and safe method for the retrieval of tubular foreign bodies, and one which involves minimal injury to the patient.

Show MeSH
Related in: MedlinePlus