RETRIEVAL OF INTRAVASCULAR FOREIGN-BODIES - EXPERIENCE IN 32 CASES

OBJECTIVE. Recent reports suggest that both the nature of intravascula r foreign bodies and the tools available to retrieve them have changed substantially in the past decade. We reviewed our recent experience w ith percutaneous retrieval of intravascular foreign bodies to determin e the efficacy and safety of the procedure using currently available d evices. MATERIALS AND METHODS. Between 1990 and 1994, we attempted ret rieval of 35 intravascular foreign bodies in 32 patients. Twelve patie nts (38%), including all five with intraarterial foreign bodies, were treated for complications of transcatheter interventional procedures t hat resulted in embolization of seven coils, four intravascular stents , an inferior vena cava filter, and a valvuloplasty balloon fragment. From procedure records, we reviewed the types of retrieval devices and methods used; the medical record was studied to determine the occurre nce and treatment of any procedure-related complications. RESULTS. Ret rieval was successful in 31 (97%) of 32 patients, All five intraarteri al and 29 of 30 IV objects were removed. Nitinol goose-neck snares wer e used in 28 of 32 cases, but more than one retrieval system was requi red in eight cases (25%), often using grasping forceps, tip-deflecting wires, or stone baskets to move the foreign body into a more favorabl e position for snaring. In the single failure, the tip of a largely ex travascular catheter fragment lay in a venous valve and could not be s nared in a patient who refused surgery, Two of five patients with arte rial foreign bodies suffered occlusive arterial spasm, reversible with local administration of nitroglycerine. Two large objects were reposi tioned to the femoral vein and removed by surgical cutdown, No other p rocedural complications occurred, and none of the patients required ad ditional compression, transfusion, or surgical intervention. CONCLUSIO N. We conclude that use of preformed nitinol goose-neck snares facilit ates retrieval of intravascular foreign bodies in most cases, although interventional radiologists must be familiar with a variety of techni ques to deal with the expanding spectrum of foreign bodies currently e ncountered.