CARDIOVASCULAR JOURNAL OF AFRICA • Vol 23, No 8, September 2012
e8
AFRICA
15-
mm angioplasty balloon was placed into the shaft and inflated
to its rated bursting pressure (Fig. 2B). The system as a unit
(
catheter, balloon and broken shaft) was eased back. When the
broken shaft arrived at the tip of the left femoral artery sheath
(
Fig. 3), the vascular surgeon made a small incision through
the skin and into the left femoral artery. The shaft and inflated
balloon were removed and the surgeon repaired the femoral
artery.
The patient was discharged from hospital after coronary
artery bypass grafting without any complication related to the
percutaneous procedure.
Discussion
Various percutaneous retrieval devices have been developed for
intravascular foreign bodies and have been used successfully
Fig. 3. The shaft was moved to the left femoral artery with
the help of the inflated balloon within it.
for many years.
1–5
Most foreign bodies are defined as catheter
fragments, guidewires, stents, pace leads, vena cava filters and
cardiac valve fragments.
1–3
However, to the best of our knowledge
this is the first case in the literature of a part of the arterial sheath
embolising shortly after vascular intervention.
We used a 7F sheath, which was the largest available in our
catheter laboratory at that time, for the contralateral femoral
artery. Another method would have been to insert a new, larger
sheath via the ipsilateral femoral artery and using the same
method, the removal might have been easier with a single arterial
access. However, in our case, location of the sheath fragment
necessitated a too-high or too-low ipsilateral femoral artery
puncture, so we did not use the ipsilateral access.
This was a simple procedure, and at least two sizes larger
French sheathes could be used to remove such foreign bodies
percutaneously without surgical consultation.
Conclusion
Retrieval devices such as snares and forceps should be the
standard percutaneous treatment modality for endovascular
foreign body retrieval. However, if retrieval is not possible
within a short time, the above method could be used for selected
patients before surgical consultation.
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shaft
guiding
balloon
