Retrieval of intravascular foreign bodies: experience in 32 cases

Recent reports suggest that both the nature of intravascular foreign bodies and the tools available to retrieve them have changed substantially in the past decade. We reviewed our recent experience with percutaneous retrieval of intravascular foreign bodies to determine the efficacy and safety of the procedure using currently available devices.

Between 1990 and 1994, we attempted retrieval of 35 intravascular foreign bodies in 32 patients. Twelve patients (38%), including all five with intraarterial foreign bodies, were treated for complications of transcatheter interventional procedures that resulted in embolization of seven coils, four intravascular stents, an inferior vena cava filter, and a valvuloplasty balloon fragment. From procedure records, we reviewed the types of retrieval devices and methods used; the medical record was studied to determine the occurrence and treatment of any procedure-related complications.

Retrieval was successful in 31 (97%) of 32 patients. All five intraarterial and 29 of 30 IV objects were removed. Nitinol goose-neck snares were used in 28 of 32 cases, but more than one retrieval system was required in eight cases (25%), often using grasping forceps, tip-deflecting wires, or stone baskets to move the foreign body into a more favorable position for snaring. In the single failure, the tip of a largely extravascular catheter fragment lay in a venous valve and could not be snared in a patient who refused surgery. Two of five patients with arterial foreign bodies suffered occlusive arterial spasm, reversible with local administration of nitroglycerine. Two large objects were repositioned to the femoral vein and removed by surgical cutdown. No other procedural complications occurred, and none of the patients required additional compression, transfusion, or surgical intervention.

We conclude that use of preformed nitinol goose-neck snares facilitates retrieval of intravascular foreign bodies in most cases, although interventional radiologists must be familiar with a variety of techniques to deal with the expanding spectrum of foreign bodies currently encountered.