Percutaneous retrieval of a misplaced titanium Greenfield filter

Comparison of Two Foreign Body Retrieval Devices with Adjustable Loops in a Swine Model

The purpose of the study was to compare two similar foreign body retrieval devices, the Texan (TX) and the Texan LONGhorn (TX-LG), in a swine model. Both devices feature a < or = 30-mm adjustable loop. Capture times and total procedure times for retrieving foreign bodies from the infrarenal aorta, inferior vena cava, and stomach were compared. All attempts with both devices (TX, n = 15; TX-LG, n = 14) were successful. Foreign bodies in the vasculature were captured quickly using both devices (mean +/- SD, 88 +/- 106 sec for TX vs 67 +/- 42 sec for TX-LG) with no significant difference between them. The TX-LG, however, allowed significantly better capture times than the TX in the stomach (p = 0.022), Overall, capture times for the TX-LG were significantly better than for the TX (p = 0.029). There was no significant difference between the total procedure times in any anatomic region. TX-LG performed significantly better than the TX in the stomach and therefore overall. The better torque control and maneuverability of TX-LG resulted in better performance in large anatomic spaces.

Comparison of the Texan Foreign Body Retrieval Device and the Amplatz Goose Neck Snare in Vivo and in Vitro

PURPOSE

To compare the capturing ability of the Texan foreign body retrieval device with that of the Amplatz gooseneck snare in a swine model and to analyze their capturing mechanisms.

MATERIALS AND METHODS

The Texan device with a < or = 30-mm adjustable loop was compared with the 5-mm, 15-mm, and 35-mm Amplatz snares for retrieval of foreign bodies from the iliac vein, infrarenal aorta, inferior vena cava, and stomach. Capture times by two investigators were compared.

RESULTS

All 24 attempts with the Texan device were successful, as were 21 of 23 attempts with the Amplatz snare; two attempts with the 5-mm Amplatz snare were abandoned, and the failures were attributed to the suboptimal size of the snare. Other than the two abandoned attempts, there was no difference between the capturing performances of the Texan device and the 5-mm, 15-mm, and 35-mm Amplatz snares when they were compared side by side. In all vascular interventions, however, the Texan device performed significantly better in capture times than did the 5-mm and 15-mm Amplatz snare (P = .015). In all interventions, the Texan device performed significantly better in capture times than did all three sizes of the Amplatz snare (P= .012).

CONCLUSION

The overall performance of the Texan device based on its capturing ability was significantly better than that of the Amplatz snares. The adjustability of the loop and the more versatile capturing technique made capture and retrieval of foreign bodies easier.

Retrieval of a Malpositioned Vena Cava Filter with Embolic Protection with Use of a Second Filter

Proper positioning of inferior vena cava (IVC) filters is necessary for effective protection from pulmonary embolism (PE). This report describes a case of an IVC filter malpositioned partially in the right common iliac vein that resulted in risk of recurrent PE caused by thrombus emanating from the left common iliac vein. A new filter was placed in the IVC above the first device, followed by retrieval of the malpositioned filter through the new filter.

Guidewire entrapment during Greenfield filter deployment

Prevention of pulmonary embolism by inferior vena cava filter has long been established. The Greenfield filter continues to be modified to improve deployment methods. A new filter design allows insertion through tortuous anatomy. We present, by way of a case report, a unique complication related to this design. The filter design, deployment technique, and the rationale behind them are discussed. Suggestions for avoiding this problem are provided.

Successful retrieval of unexpanded Palmaz-Schatz stent from left main coronary artery

A 64-year-old patient with silent myocardial ischemia after anterior myocardial infarction was treated with directional coronary atherectomy, balloon angioplasty, and placement of Palmaz-Schatz stent. An unexpanded Palmaz-Schatz stent was retained in the left main coronary artery and was treated successfully with a nitinol goose-neck snare. After this procedure, another Palmaz-Schatz stent was successfully implanted without any complications.