Percutaneous retrieval of complicated intravascular devices

Abstract

Background: Cardiac catheterization procedures are sometimes associated with unanticipated serious complications related to intravascular devices (IVD) which include embolization, displacement, knotting, entrapment etc. Percutaneous management is difficult and may even warrant surgical extraction. We evaluated clinical profile, causes, management and outcomes of percutaneous retrieval of such complicated IVD Methods and Findings: In this retrospective, single-center study, medical and procedural records of all patients who had undergone percutaneous retrieval of complicated IVD using combination of guide catheters and snares between January 2013 and January 2018 were examined. A total of 11 patients with complicated IVD were diagnosed, with mean age of 48.27±15 years. Eight (72.7%) patients were asymptomatic, while three (27.3%) patients had clinical findings including hematuria, hypotension and bradyarrhythmia. Complicated IVD involved were central venous pressure guide wires in four (36.4%), coronary stents in two (18.2%) and patent ductus arteriosus closure device, atrial septal defect closure device, ventricular septal defect closure device, temporary pacing lead and 0.035" guidewire each in one case. Probable mechanisms that could have led to complications were loss of control in five (45.5%), migration due to incorrect deployment in two (18.2%), migration due to complex coronary anatomy in two (18.2%), blind insertion without fluoroscopy in one (9.1%), and incorrect sizing or device malfunction in one (9.1%) case. Percutaneous retrieval was successful in 10 (90.9%) patients, while one (9.1%) patient with migrated coronary stent required opensurgical retrieval. There were no procedure-related complications. Conclusions: Patients with complicated IVD, warranting retrieval, may have variable clinical presentation and multifactorial causes. Percutaneous retrieval of such devices has a higher success rate with minimal complications.

Intravascular Foreign Body Retrieval

“…There are various retrieval devices available for endovascular IFBR: snares, Dormia baskets, biopsy forceps, tip-deflecting wires, pincher devices, oversized sheaths or balloon catheters. 1 However, like in our series, the large majority of endovascular IFBR uses a snare. In one series, only 8.7% of displaced devices were retrieved with a device other than a snare.…”

“…Those located within the cardio-pulmonary system pose the most significant risk. 1,7 Infectious complications are high in broken catheter fragments; it arises from bacterial contamination. Misplaced coils cause local thrombogenicity, ischemia, and perforation.…”

“…In the exponentially increasing cardiac catheterization procedures, IFB malpositioning or embolization incidence is about 0.1%-0.9%. [1][2][3][4] The higher number of patients under dialysis or chemotherapy has increased the use of intravascular devices. Accordingly, most cases of IFBR occur in dialysis and oncology patients.…”

“…Reported issues with embolization coils usually occur when the delivery catheter or the undersized coil positions are not stable. 1,2 Intravascular foreign body retrieval (IFBR) can be achieved using percutaneous techniques, open surgery, or both combined.…”

Formulation and Characterization of Bromocriptine Mesylate as Liquid Self-Nano Emulsifying Drug Delivery System

“…BM was dissolved in castor oil in a screw-capped glass container and mixed with other components at the concentration of (2.5 mg / 0.3 ml) and heated in a water bath at (50 -60°C) to facilitate homogenization. The components were mixed by vortex mixing for 5 min to obtain a clear, uniform mixture and again cooled to room temperature followed by equilibrating the mixture on a sonication at a room temperature for 10 min, after that the formulations were kept under visual observation for at least 48h (at room temperature) and examined for any signs of turbidity or phase separation prior to droplet size distribution studies (13)(14)(15) .…”