నైరూప్య

Percutaneous retrieval of complicated intravascular devices

Jaywant Nawale, Ajay Chaurasia, Digvijay Nalawade, Sandeep Kamat, Meghav Shah

Background: Cardiac catheterization procedures are sometimes associated with unanticipated serious complications related to intravascular devices (IVD) which include embolization, displacement, knotting, entrapment etc. Percutaneous management is difficult and may even warrant surgical extraction. We evaluated clinical profile, causes, management and outcomes of percutaneous retrieval of such complicated IVD Methods and Findings: In this retrospective, single-center study, medical and procedural records of all patients who had undergone percutaneous retrieval of complicated IVD using combination of guide catheters and snares between January 2013 and January 2018 were examined. A total of 11 patients with complicated IVD were diagnosed, with mean age of 48.27±15 years. Eight (72.7%) patients were asymptomatic, while three (27.3%) patients had clinical findings including hematuria, hypotension and bradyarrhythmia. Complicated IVD involved were central venous pressure guide wires in four (36.4%), coronary stents in two (18.2%) and patent ductus arteriosus closure device, atrial septal defect closure device, ventricular septal defect closure device, temporary pacing lead and 0.035” guidewire each in one case. Probable mechanisms that could have led to complications were loss of control in five (45.5%), migration due to incorrect deployment in two (18.2%), migration due to complex coronary anatomy in two (18.2%), blind insertion without fluoroscopy in one (9.1%), and incorrect sizing or device malfunction in one (9.1%) case. Percutaneous retrieval was successful in 10 (90.9%) patients, while one (9.1%) patient with migrated coronary stent required opensurgical retrieval. There were no procedure-related complications. Conclusions: Patients with complicated IVD, warranting retrieval, may have variable clinical presentation and multifactorial causes. Percutaneous retrieval of such devices has a higher success rate with minimal complications.