Interventional Removal of Intravascular Medical Devices: Methods and Technical Success

Abstract

Purpose: Evaluation of the technical success rate and complications when retrieving dislocated intravascular foreign bodies.

Material and Methods: Between 1999 and 2015 38 patients (21 female; 17 male; Age: 17 – 92; Average 54.3 years) underwent an extraction of intravascular dislocated foreign bodies, which were not lost during a radiological intervention. The extracted material included 29 port catheters, 3 tips of tunneled dialysis catheters, 2 stents, 2 guide wires, 1 CVC tip and 1 AS occluder device. Various catheters for repositioning and extraction were used. The access was transarterial as well as transvenous. Technical success was defined as complete removal of the foreign body.

Results: The technical success rate was 92.1 % (35 of 38). In 17 patients an additional catheter was necessary to reposition the foreign body in order to make it accessible for the extraction catheter. In one case a stent was relocated and remodeled within the patient and was not extracted. In another case we experienced a dislocation of a small fragment of the port catheter into the distal parts of the pulmonary artery, which couldn’t be extracted. A guide wire could not be extracted as it was already adhered with the vessel wall. Peri-interventional complications were not documented.

Conclusion: The percutaneous extraction of dislocated intravascular foreign bodies is technically successful and poor of complications. Interventional therapy can avoid surgical removal.

Key points:

• The percutaneous extraction of dislocated intravascular foreign bodies is technically successful and safe.

• In most cases surgical removal can be avoided.

• The gooseneck-snare catheter was mainly used for the extraction of intravascular foreign bodies.

Citation Format:

• Ayx I, Goessmann H, Hubauer H et al. Interventional Removal of Intravascular Medical Devices: Methods and Technical Success. Fortschr Röntgenstr 2016; 188: 566 – 573

Zusammenfassung

Ziel: Evaluation des technischen Erfolgs und der Komplikationsrate bei der Bergung von intravasal disloziertem Fremdmaterial.

Material und Methoden: Zwischen 1999 und 2015 wurde bei 38 Patienten (21 Frauen, 17 Männer; Alter: 17 – 92 Jahre; Durchschnitt: 54,3 Jahre) eine Bergung von intravasal disloziertem Fremdmaterial durchgeführt, welches nicht im Rahmen einer radiologischen Intervention verloren wurde. Bei 29 Portkathetern, 3 getunnelten Dialysekatheter, 2 Stents, 2 Führungsdrähten, einer ZVK-Spitze und einem Schirmchen zur Okklusion eines Vorhofseptumdefekts wurden verschiedene Repositionskatheter, Extraktionskatheter und Zugänge (arteriell, venös) verwendet.

Ergebnisse: Die vollständige Bergung des Fremdmaterials war in 92,1 % erfolgreich (35 von 38 Fällen). In 17 Fällen war eine Reposition mittels eines Hilfskatheters nötig, um das Fremdmaterial dem Bergekatheter zugänglich zu machen. Ein Stent wurde intrakorporal anmodelliert und nicht geborgen. Bei der Bergung eines Portkatheterschlauches kam es zu einer Dislokation eines kleinen Schlauchanteiles in die distalen Anteile der A. pulmonalis. Dieser konnte nicht mehr geborgen werden. Ein Führungsdraht entlang der Aorta thoracalis/abdominalis imponierte schon mit der Gefäßwand verwachsen, eine Bergung war nicht mehr möglich. Periinterventionelle Komplikationen wurden nicht verzeichnet.

Schlussfolgerung: Die Bergung von intravasal disloziertem Fremdmaterial ist technisch erfolgreich und komplikationsarm durchzuführen. Eine operative Entfernung kann meist vermieden werden.

Key words

angiography - interventional procedures - safety - technical aspects

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