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Intravascular foreign bodies (IVFB) are a well-described complication of endovascular procedures with significant morbidity and mortality. Retrieval of the IVFB is indicated if at all possible. Retrieval of IVFBs can be complex based on the location and cumbersome nature of the embolized device. Technological advancements are already assisting with IVFB retrieval. Steerable catheters represent an advancement in the field of IVFB retrieval. In our lab, we have adopted the Dexterity steerable catheter (Spirus Medical, Bridgewater, MA, USA). We present three cases of IVFB retrieval using a steerable catheter.
Case 1: A 54-year-old male with a history of idiopathic pulmonary embolism on indefinite anticoagulation who required spinal surgery underwent inferior vena cava filter. During retrieval, the filter embolized into the pulmonary artery. The patient was referred to our facility for attempt at retrieval. Pulmonary angiography confirmed that the IVC filter was in the distal left lower pulmonary artery. The steerable catheter was directed toward the filter and successfully snared.
Case 2: A 54 y/o male suffered embolization of two self-expanding femoral venous stents. Snares were advanced from an internal jugular sheath and a femoral steerable catheter. The two overlapping stents were captured by the opposing snares and pulled apart. One stent was then snared at opposite ends. Traction was applied, which forced the stents to elongate and narrow to the point of fitting inside the steerable catheter, and the stent was removed. The process was repeated for the second stent.
Case 3: A 21 y/o female with no prior medical history underwent placement of a subcutaneous birth control device. Shortly after the procedure, she could no longer feel the device beneath her skin. Radiography showed that the device had embolized to a right sub-segmental pulmonary artery. A steerable catheter was advanced into the right segmental pulmonary artery. A snare was advanced and the device was captured without vascular injury.
Successful retrieval of 3 intravascular foreign bodies without vascular injury or major bleeding.
Steerable catheters may represent a significant advancement over fixed-shape catheters in endovascular therapy, specifically retrieval of IVFBs, as shown in these cases.