Percutaneous removal of a misplaced Palmaz stent with a coaxial snare technique

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 intravascular foreign bodies with goose neck snare

PURPOSE

to evaluate the efficacy and advantages of the snare systems in the retrieval of foreign bodies from vascular system.

MATERIALS AND METHODS

the snare technique has been used for intravascular foreign body retrieval. We performed percutaneous extraction of intravascular foreign bodies using combination multipurpose catheters and a nitinol snare loop. In this report, we evaluated the patients who had performed endovascular device reposition or foreign body retrieval from 1998 to 2001.

RESULTS

foreign body retrieval was performed in 15 patients. The foreign bodies consisted of seven fractured port catheters, one sheath fragment, one embolization coil, four wire fragments, one pace-maker transducer and one dislocated endovascular stent. In no case were surgical procedures required, and no complications were encountered.

CONCLUSION

the snare technique is a useful and a safe method as an alternative procedure to surgery. This technique is highly effective with low rate complications.

Tubular foreign body or stent: safe retrieval or repositioning using the coaxial snare technique

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.

Percutaneous techniques for managing maldeployed or migrated stents

PURPOSE

To report our experience in the percutaneous management of dislocated endovascular stents.

METHODS

During a 6-year period, 28 (2.7%) patients with a maldeployed or migrated endovascular stent (20 Palmaz, 5 Wallstent, 2 Memotherm, and 1 AVE) were recognized among 1021 patients undergoing noncardiac vascular stent procedures. Percutaneous stent management was performed using balloon catheters, gooseneck snares, grasping forceps, or additional stent implantation on the basis of the stent type, degree of expansion, mechanical characteristics, and location of the stent.

RESULTS

Three stents that embolized into the pulmonary artery were left in situ, but percutaneous management was successful in 23 (92%) of the remaining 25 dislocated stents (12 venous and 13 arterial stents). Twelve stents were repositioned in an alternate, stable position or the primarily intended location; 4 stents were anchored by a second stent, and 7 stents were removed percutaneously. In the 2 failed cases, the stents were retrieved using a minor surgical procedure. There were 2 minor groin hematomas but no secondary complications during a median follow-up of 26.2 months (range 1-62).

CONCLUSIONS

Percutaneous management of migrated or maldeployed endovascular stents is highly effective with few complications. On the basis of our findings, these techniques should be considered the therapy of choice.

Percutaneous Retrieval of Lost or Misplaced Intravascular Objects

OBJECTIVE

We report on our experience with percutaneous interventional techniques for retrieval of intravascular foreign bodies or repositioning of misplaced 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 objects consisted of 12 endovascular stents, 14 catheter fragments, 11 embolization coils, four guidewire fragments, three vena cava filters, and one cardiac valve fragment. Percutaneous extraction was performed using a combination 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 patients. Of 38 patients on whom we performed percutaneous removal, the procedure was successful in 34 patients (89.5%), including 13 of the 14 patients with catheter fragments, all four of the patients with guidewire fragments, 10 of the 11 patients with misplaced or dislodged embolization coils, four of the five patients with misplaced or dislodged endovascular stents, and all three of the patients with misplaced or dislodged vena cava filters. The procedure was not successful in the one patient with a cardiac valve fragment. All seven of the percutaneous repositioning procedures we performed resulted in the endovascular stent being successfully repositioned in a stable intravascular position. Most of the retrieval procedures (77.7%) were performed using the nitinol snare as the primary instrument. No late complications 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 foreign objects or for repositioning of dislocated endovascular stents are highly effective with a low rate of complications and should always be the primary method of choice.

Management of misplaced or migrated endovascular stents

PURPOSE

To report experience with techniques for management of misplaced or migrated endovascular stents.

MATERIALS AND METHODS

During a 5-year period, percutaneous management of 27 misplaced or migrated endovascular stents (16 Palmaz, 11 Wallstents) in 25 patients was attempted. The 17 venous and 10 arterial stents were rescued from the aorta (n = 9), inferior vena cava (IVC) (n = 4), transjugular intrahepatic portosystemic shunt/IVC (n = 2), right atrium (n = 3), right ventricle (n = 2), pulmonary artery (n = 2), iliac vein (n = 2), iliac artery (n = 1), superior vena cava (n = 1), and superior mesenteric vein (n = 1).

RESULTS

Stent management was successful in 26 of 27 cases (96%). Eleven stents were removed percutaneously, two were repositioned and removed with a minor surgical procedure, and 13 were repositioned and deployed in a stable alternate location. The only complication was the development of tricuspid insufficiency in the single case in which the procedure failed (4% complication rate). This patient's stent was eventually surgically removed from the right ventricle.

CONCLUSION

Misplaced or migrated endovascular Palmaz and Wallstents can be effectively managed with few complications by using a variety of percutaneous techniques.