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Percutaneous transcatheter retrieval of misplaced therapeutic embolisation devices
I C Huggon1, S A Qureshi, J Reidy
1Department of Paediatric Cardiology and Radiology, Guy's Hospital, London.
Insights
Misplaced devices during therapeutic embolisation occur in 3-4% of procedures. Transcatheter retrieval is a successful management strategy, avoiding surgery and allowing completion of embolisation.
Area of Science:
- Interventional Cardiology
- Medical Device Technology
Background:
- Therapeutic embolisation is a key treatment for congenital heart disease.
- Device misplacement is a potential complication during these procedures.
Purpose of the Study:
- To determine the incidence of device misplacement during therapeutic embolisation.
- To evaluate the effectiveness of transcatheter retrieval for managing misplaced devices.
Main Methods:
- Retrospective review of case notes, cardiac catheterisation reports, and angiograms.
- Analysis of 231 therapeutic embolisation procedures in 205 patients with congenital heart disease.
- Assessment of device misplacement and retrieval rates, morbidity, and mortality.
Main Results:
- The incidence of device misplacement was 3% of deployed devices and 4.3% of procedures.
- Transcatheter retrieval was successful in 80% of misplacement cases (8/10 patients).
- No deaths or serious sequelae occurred; one patient required surgery for retrieval.
Conclusions:
- Device misplacement is a manageable complication of therapeutic embolisation.
- Transcatheter retrieval is a safe and effective alternative to surgery.
- Availability of diverse retrieval equipment and expertise is crucial for successful retrieval.
Objective:
To assess the incidence and subsequent management of misplaced devices as a complication of therapeutic embolisation procedures.
Design:
Retrospective review of case notes, cardiac catheterisation reports, and angiograms.
Setting:
Tertiary referral centre for congenital heart disease.
Patients:
205 consecutive children and adults undergoing therapeutic embolisation for congenital heart disease in the 10 years up to 1 April 1993. This group had 231 therapeutic embolisation procedures at 241 sites using coils, umbrella devices, or detachable balloons.
Main Outcome Measures:
Incidences of misplacement and retrieval of the device; morbidity and mortality.
Results:
The incidence of misplacement was 3% (10/332) of devices deployed and 4.3% (10/231) of procedures performed. Retrieval from distal pulmonary arteries was not attempted in two patients, but transcatheter retrieval of coils and umbrellas from systemic and pulmonary vessels, using snares or retrieval baskets, was successful in the remaining eight. There were no deaths or serious sequelae related to the procedure, but one patient required femoral arteriotomy for removal of an umbrella device retrieved only as far as the groin. In four of the five most recent cases, the misplaced device was retrieved and the therapeutic embolisation was completed at the same procedure.
Conclusions:
Misplacement of a device during therapeutic embolisation is a recognised complication that can be satisfactorily dealt with by transcatheter retrieval without recourse to surgery. For retrieval to be successful it is important to have a wide selection of retrieval equipment available and to be conversant with its use.