Intravascular foreign body retrieval

Intravascular foreign body (IFB) embolization is a potential complication of any vascular procedure. Intravascular foreign body retrieval (IFBR) can be achieved using percutaneous techniques, open surgery, or both combined.

We completed a retrospective review of patients who underwent endovascular or open IFBR since 2011 on our institution. Primary end-point was technical retrieval success, and secondary end-points were procedure-related compli- cations and 30-days survival.

Twenty-seven patients underwent IFBR. Median time from intravascular device loss and retrieval was less than one day. 67% were non-endovascular guidewires and sheath fragments (N=28). 59% of IFBs were lost during their deployment (N=16); 41% during their removal attempts (N=11). 44% were lost in the arterial system (N=12) and 52% in the venous system (N=14). An endovascular procedure was used as the first approach in IFBR in 56% of patients (N=15) and open procedure in 44% (N=12). In the presence of IFB on the thoracic or abdominal cavity, it was always tried a first-endo approach; if IFB was present on the neck or limbs, 75% were retrieved by open surgery (N=20; p<0.001). Success rates were 100% for open and 87% for endovascular procedures. IFB caused five acute complications: one IJV thrombosis, two strokes and three acute limb ischemia. There were no IFBR-related complications. 30 days-survival was 100%.

Embolization of IFBs can be minimized with proper device selection, deployment and removal. In this study, open and endovascular retrieval had high success rates and minimal morbidity. Its choice is surgeon-dependent and restrained by devices availability.