Foreign Body Retrieval
by
Sridhar Kasturi
February 19, 2013Operator(s)
Dr.Sridhar Kasturi MD., DM., FACC HOD Sr.Interventional Cardiologist; Dr.Mallindra Swamy MD., DNB Consultant Cardiologist; Dr.Venkatesh MD., PDCC Consultant Intensivist & Critical Care
Affiliation
Global Hospitals, Hyderabad, India
Facility / Institute
Aware Global Hospitals, L.B.Nagar, Hyderabad,Andhrapradesh, India
Clinical History
A 77 year old male, smoker, hypertensive, and diabetic was admitted for a non-healing ulcer of the right foot with rest pain. He was referred to cardiology because of absent distal pulses in both lower limbs.
Angiography
1) LMCA : Normal
2) LAD : Proximal 99% stenosis involving the origin of the first diagonal branch, an origin (Figure 1) and a second proximal 70-80% stenosis (Figure 2). The mid LAD was normal. The distal LAD had a 60-70% stenosis. The first diagonal had a 90% ostial stenosis
3) LCX : Non dominant with a 50% mid stenosis
4) RCA: Distal 50-60% stenosis
5) Right renal artery: Mild narrowing
6) Left renal artery : Normal7) Normal aortic root and no pressure gradient
8) On the right side, the poplitial artery was normal, the posterior tibial artery was totally occluded, and the anterior tibial artery was diffusely diseased
9) On the left side, the poplitial artery was diffusely diseased as were the anterior and posterior tibial arteries
2) LAD : Proximal 99% stenosis involving the origin of the first diagonal branch, an origin (Figure 1) and a second proximal 70-80% stenosis (Figure 2). The mid LAD was normal. The distal LAD had a 60-70% stenosis. The first diagonal had a 90% ostial stenosis
3) LCX : Non dominant with a 50% mid stenosis
4) RCA: Distal 50-60% stenosis
5) Right renal artery: Mild narrowing
6) Left renal artery : Normal7) Normal aortic root and no pressure gradient
8) On the right side, the poplitial artery was normal, the posterior tibial artery was totally occluded, and the anterior tibial artery was diffusely diseased
9) On the left side, the poplitial artery was diffusely diseased as were the anterior and posterior tibial arteries
Procedure
The LMCA was engaged with a 6Fr XB 3.5 Cordis guiding catheter. A 0.014" BMW guidewire was positioned into the first diagonal branch, and the stenosis was predilated with a 1.5x10mm balloon (Figure 3, Figure 4). Another BMW guidewire was positioned in the LAD, and the stenosis was predilated with a 1.5x10mm balloon at 10atm and the stented with a 3.0x 37mm Metafor drug-eluting stent (Figure 5). Angiography showed agood result with TIMI III flow (Figure 6, Figure 7).
Next, the right femoral artery was cannulated, a 6Fr JR3.5 Cordis guiding catheter was passed up the distal superficial femoral artery, and a 0.014" Whisper XT guidewire crossed the proximal popliteal artery with the help of balloon support. HOwever, during the procedure, the balloon shaft broke (Figure 8). An attempt to use a snare to retrieve the broken balloon was not successful. Therefore, we folded a coronary guidewire (Figure 9) and inserted it into the femoral artery, pushed it to the popliteal artery level, and gradually withdrew it to capture broken balloon shaft (Figure 10).
Next, the right femoral artery was cannulated, a 6Fr JR3.5 Cordis guiding catheter was passed up the distal superficial femoral artery, and a 0.014" Whisper XT guidewire crossed the proximal popliteal artery with the help of balloon support. HOwever, during the procedure, the balloon shaft broke (Figure 8). An attempt to use a snare to retrieve the broken balloon was not successful. Therefore, we folded a coronary guidewire (Figure 9) and inserted it into the femoral artery, pushed it to the popliteal artery level, and gradually withdrew it to capture broken balloon shaft (Figure 10).
Conclusion(s) / Result(s)
Ultimately the broken balloon shaft successfully retrieved through the femoral sheath (Figure 11, Figure 12).
Comments/Lessons
None
Gallery
Conflicts of Interest
None
Comments