Interventionalists learn to pick up after themselves and others

For one reason or another, objects sometimes dislodge from their safe perches within the body and end up stranded intravascularly.

Two studies presented on Sunday at the European Congress of Radiology reported that current percutaneous techniques for the retrieval of these foreign bodies are highly effective.

"Percutaneous approaches should always be the primary method of choice when retrieving intravascular foreign bodies," said Dr. Florian Wolf, an interventional radiologist at the University of Vienna.

Wolf and colleagues from the department of angiography and interventional radiology retrospectively reviewed records of 50 patients referred for percutaneous retrieval of 50 intravascular objects between May 1994 and May 2002.

Objects scheduled for removal included:
? catheter fragments (38%)
? port-a-cath parts (24%)
? pacemaker cables (20%)
? guidewire fragments (10%)
? other foreign bodies (8%)

Nineteen objects were in the right heart, 16 in the venous system, nine in the pulmonary artery, five in the arterial system, and one in a dialysis shunt in the forearm.

Austrian interventionalists used a gooseneck snare to remove or reposition the objects in 48 cases, and a sidewinder catheter in two.

In 39 of 50 cases, the foreign body was successfully removed. In one case, the tip of a port-a-cath was successfully repositioned. Five objects could not be completely removed, and three could not be identified. In two cases, a small venous access necessitated surgical removal. Minor complications occurred in five cases.

In the second paper, Dr. Juhn-Cherng Liu reported successfully removing 23 of 24 intravascular foreign bodies.

The lost objects were 17 port-a-cath fragments (16 intracardiac), three hemodialysis catheter fragments, two central venous catheter guidewires, one central venous catheter fragment, and one Swan-Ganz catheter.

Liu and colleagues from the Taipei Veterans General Hospital retrieved 15 objects with loop snare catheters and eight with Dormia basket retrievers. The one failure involved grasping forceps.

"The major cause of intravascular foreign body embolization was improper procedure handling," Liu said.

He concluded that these types of objects can be removed easily and safely with currently available percutaneous methods and devices.

"Interventional approaches to retrieval of lost objects can help avoid major surgery, particularly for intracardiac embolization," he said.