Korean J Radiol.  2002 Mar;3(1):30-37. 10.3348/kjr.2002.3.1.30.

Tubular Foreign Body or Stent: Safe Retrieval or Repositioning Using the Coaxial Snare Technique

• Seong CK
• Kim YJ
• Chung JW
• Kim SH
• Kim HB
• Park JH

• KMID: 1758444
• DOI: http://doi.org/10.3348/kjr.2002.3.1.30

Abstract

OBJECTIVE
To evaluate the utility and advantages of the coaxial snare technique in the retrieval of tubular foreign bodies.
MATERIALS AND METHODS
Using the coaxial snare technique, we attempted to retrieve tubular foreign bodies present in seven patients. The bodies were either stents which were malpositioned or had migrated from their correct position in the vascular system (n=2), a fragmented venous introducer sheath (n=1), fragmented drainage catheters in the biliary tree (n=2), or fractured external drainage catheters in the urinary tract (n=2). After passing a guidewire and/or a dilator through the lumina of these foreign bodies, we introduced a loop snare over the guidewire or dilator, thus capturing and retrieving them.
RESULTS
In all cases, it was possible to retrieve or reposition the various items, using a minimum-sized introducer sheath or a tract. No folding was involved. In no case were surgical procedures required, and no complications were encountered.
CONCLUSION
The coaxial snare technique, an application of the loop snare technique, is a useful and safe method for the retrieval of tubular foreign bodies, and one which involves minimal injury to the patient.

Keyword

Catheters and catheterization, complications; Foreign bodies; Interventional procedures

MeSH Terms

Adult
Case Report
Catheters, Indwelling
Drainage/instrumentation
Foreign Bodies/*radiography/*therapy
Foreign-Body Migration
Human
Male
Middle Age
*Stents

Figure

• 

  Fig. 1 Ex-vivo study of coaxial snaring of a vascular stent. A. Simple snaring (arrow) of a Niti-S stent results in the formation of a right angle between the stent and the snare axis. Retrieval of the stent in this configuration would therefore be traumatic. B. Coaxial snaring of the stent while a guidewire (small arrows) runs through it reduces the angle between the stent and the introducer sheath (large arrows), thus allowing repositioning of the stent through the TIPS tract.

• 

  Fig. 2 Ex-vivo study of coaxial snaring of a small-bore catheter fragment (5-F). A. Simple snaring of the catheter fragment also causes an angulation problem. B. Coaxial snaring reduces the angle between the catheter fragment and the snaring catheter. Note that the guidewire was positioned through the lumen of the catheter fragment. C. There is smooth engagement between the catheter fragment and the 10-F sheath.

• 

  Fig. 3 Ex-vivo study of the retrieval of a large-bore sheath fragment (8-F internal diameter and 10-F outer diameter) using a modified coaxial snare technique. A. In the large-bore fragmented vascular sheath, the simple coaxial snare technique does not allow engagement between the fragment and the 10-F or 12-F introducer sheath. The overall profile of the coaxial retrieval system is more than 14-F, with a shoulder between the 10-F introducer sheath (black arrow) and the sheath fragment (white arrows). B. The loop snare introduced through the smaller sheath (10-F) captures the fractured vascular sheath. Separate access is obtained via the larger sheath (12-F), and the central lumen of the fractured sheath is located with an angiographic catheter and guidewire. C. After engaging a dilator (small black arrow) at its end, the fragmented sheath (white arrow) is seen to be smoothly aligned with the introducer sheath (large black arrow).

• 

  Fig. 4 Relocation of a stent employed in a TIPS procedure using the coaxial snare technique. A. The deployed nitinol stent has migrated caudad to the main portal vein. The inflated gastric balloon signifies that the patient is actively bleeding. B. The loop of an Amplatz gooseneck snare is introduced over the preexisting guidewire and positioned around the stent. C. After a loop snare was used to squeeze the proximal end of the stent, this was pulled back and relocated to its appropriate position. D. A digital subtraction angiogram obtained after relocation shows rapid flow from the superior mesenteric vein to the right atrium via the created TIPS tract.

• 

  Fig. 5 Retrieval of a large-bore sheath fragment using a modified coaxial snare technique. A. During bedside placement of an internal jugular venous catheter, the tip of this sheared off and lodged in the right atrium. The fragment was captured by a gooseneck snare and pulled back into the inferior vena cava. B. The femoral vein was punctured a second time, just above the puncture site for the loop snare, and a 12-F vascular sheath was introduced. With the assistance of a loop snare, the fragment has successfully engaged with the dilator of the vascular sheath. C. The whole system was slowly withdrawn until the sheath fragment appeared at the puncture site. The linear mark represents the puncture site for the loop snare.

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  Fig. 6 Retrieval of a catheter fragment (10.2-F) from the renal pelvis using the coaxial snare technique. A. Because the fragmented catheter was tightly attached to the wall of the pelvocalyceal system, other method failed to capture it. B. After passing a guidewire through the catheter lumen, the end of the catheter was easily captured by a loop snare introduced coaxially over the guidewire. A second small fragmented catheter tip is also seen. C. Photograph of the entire extracted retrieval system. The catheter fragment is firmly grasped by the retracting loop snare, and for smooth extraction, a 10-F dilator has been introduced into the catheter fragment over the guidewire.

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