Percutaneous retrieval of lost or misplaced intravascular objects

OBJECTIVE. We report on our experience with percutaneous interventional tec hniques for retrieval of intravascular foreign bodies or repositioning of m isplaced endovascular prostheses. MATERIALS AND METHODS. Over a period of 6 years, we attempted percutaneous treatment of intravascular foreign bodies in 45 patients. The 45 foreign ob jects consisted of 12 endovascular stents, 14 catheter fragments, 11 emboli zation coils, four guidewire fragments, three vena cava filters, and one ca rdiac valve fragment. Percutaneous extraction was performed using a combina tion of multipurpose catheters and nitinol snare loop or grasping forceps. Depending on their composition, misplaced or dislodged intravascular stents were either repositioned or percutaneously removed. RESULTS. Percutaneous intervention was successful in 41 (91.1%) of 45 patie nts. Of 38 patients on whom we performed percutaneous removal, the procedur e was successful in 34 patients (89.5%), including 13 of the 14 patients wi th catheter fragments, all four of the patients with guidewire fragments, 1 0 of the 11 patients with misplaced or dislodged embolization coils, four o f the five patients with misplaced or dislodged endovascular stents, and al l three of the patients with misplaced or dislodged vena cava filters. The procedure was not successful in the one patient with a cardiac valve fragme nt. All seven of the percutaneous repositioning procedures we performed res ulted in the endovascular stent being successfully repositioned in a stable intravascular position. Most of the retrieval procedures (77.7%) were perf ormed using the nitinol snare as the primary instrument. No late complicati ons were registered during the follow-up period, which ranged from 9 to 68 months (mean, 42.4 months overall). CONCLUSION. Percutaneous techniques for the extraction of intravascular for eign objects or for repositioning of dislocated endovascular stents are hig hly effective with a low rate of complications and should, always be the pr imary method of choice.