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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

Retrieval of a large-bore sheath fragment using a modified coaxial snare technique.A. During bedside placement of an internal jugular venous catheter, the tip of this sheared off and lodged in the right atrium. The fragment was captured by a gooseneck snare and pulled back into the inferior vena cava.B. The femoral vein was punctured a second time, just above the puncture site for the loop snare, and a 12-F vascular sheath was introduced. With the assistance of a loop snare, the fragment has successfully engaged with the dilator of the vascular sheath.C. The whole system was slowly withdrawn until the sheath fragment appeared at the puncture site. The linear mark represents the puncture site for the loop snare.
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Figure 5: Retrieval of a large-bore sheath fragment using a modified coaxial snare technique.A. During bedside placement of an internal jugular venous catheter, the tip of this sheared off and lodged in the right atrium. The fragment was captured by a gooseneck snare and pulled back into the inferior vena cava.B. The femoral vein was punctured a second time, just above the puncture site for the loop snare, and a 12-F vascular sheath was introduced. With the assistance of a loop snare, the fragment has successfully engaged with the dilator of the vascular sheath.C. The whole system was slowly withdrawn until the sheath fragment appeared at the puncture site. The linear mark represents the puncture site for the loop snare.

Mentions: Case 3. A 42-year-old man with chronic renal failure underwent internal jugular venous catheterization at the bedside. During the procedure, the tip of the 8-F internal diameter venous introducer sheath fractured and migrated to the right atrium. Because the fragment moved vigorously in accordance with the patient's heartbeat, it was necessary to prevent its migration to the right ventricle or pulmonary circulation. Under fluoroscopic guidance, we inserted a 10-mm gooseneck snare through the right common femoral vein, successfully grasping the fragment and carefully pulling it back into the inferior vena cava (Fig. 5A). Because the fragment was very stiff and its outer diameter was 10-F, it had to be removed without folding. To this end, we used the modified coaxial technique illustrated in the ex-vivo study (Figs. 3B, 3C), inserting another 12-F vascular sheath (13 cm in length). The puncture site was more cranial to the previous one, used for insertion of the loop snare; the central lumen of the fragment was carefully located using an angiographic catheter and guidewire, and the dilator for the vascular sheath was then introduced over the guidewire (Fig. 5B). The entire retrieval system mirrored the one used in the ex-vivo experiment. After the dilator and the end of the sheath fragment were tightly engaged, the whole system was pulled back until the end of the fragment appeared at the femoral access site. It was grasped with forceps and successfully extracted after release of the loop snare and careful compression of the puncture site (Fig. 5C).


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)

Retrieval of a large-bore sheath fragment using a modified coaxial snare technique.A. During bedside placement of an internal jugular venous catheter, the tip of this sheared off and lodged in the right atrium. The fragment was captured by a gooseneck snare and pulled back into the inferior vena cava.B. The femoral vein was punctured a second time, just above the puncture site for the loop snare, and a 12-F vascular sheath was introduced. With the assistance of a loop snare, the fragment has successfully engaged with the dilator of the vascular sheath.C. The whole system was slowly withdrawn until the sheath fragment appeared at the puncture site. The linear mark represents the puncture site for the loop snare.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 5: Retrieval of a large-bore sheath fragment using a modified coaxial snare technique.A. During bedside placement of an internal jugular venous catheter, the tip of this sheared off and lodged in the right atrium. The fragment was captured by a gooseneck snare and pulled back into the inferior vena cava.B. The femoral vein was punctured a second time, just above the puncture site for the loop snare, and a 12-F vascular sheath was introduced. With the assistance of a loop snare, the fragment has successfully engaged with the dilator of the vascular sheath.C. The whole system was slowly withdrawn until the sheath fragment appeared at the puncture site. The linear mark represents the puncture site for the loop snare.
Mentions: Case 3. A 42-year-old man with chronic renal failure underwent internal jugular venous catheterization at the bedside. During the procedure, the tip of the 8-F internal diameter venous introducer sheath fractured and migrated to the right atrium. Because the fragment moved vigorously in accordance with the patient's heartbeat, it was necessary to prevent its migration to the right ventricle or pulmonary circulation. Under fluoroscopic guidance, we inserted a 10-mm gooseneck snare through the right common femoral vein, successfully grasping the fragment and carefully pulling it back into the inferior vena cava (Fig. 5A). Because the fragment was very stiff and its outer diameter was 10-F, it had to be removed without folding. To this end, we used the modified coaxial technique illustrated in the ex-vivo study (Figs. 3B, 3C), inserting another 12-F vascular sheath (13 cm in length). The puncture site was more cranial to the previous one, used for insertion of the loop snare; the central lumen of the fragment was carefully located using an angiographic catheter and guidewire, and the dilator for the vascular sheath was then introduced over the guidewire (Fig. 5B). The entire retrieval system mirrored the one used in the ex-vivo experiment. After the dilator and the end of the sheath fragment were tightly engaged, the whole system was pulled back until the end of the fragment appeared at the femoral access site. It was grasped with forceps and successfully extracted after release of the loop snare and careful compression of the puncture site (Fig. 5C).

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