Cardiovascular Journal of Africa: Vol 26 No 2 (March/April 2015)

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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 26, No 2, March/April 2015 AFRICA e11
have increasingly been used in the treatment of selected patients
with a variety of peripheral vascular injuries.4
Since the first report of transfemoral endovascular exclusion
of an abdominal aortic aneurysm (AAA) by Parodi in 1991,
significant early clinical experience using different endovascular
devices for the treatment of aortic aneurysms has been
accumulated. Endovascular treatment of peripheral arterial
aneurysms, pseudo-aneurysms and arteriovenous fistulae has
become feasible as a natural extension of the endovascular
techniques initially devised for the treatment of aortic aneurysms
and arterial occlusive disease.5
The potential advantages of endovascular repair of peripheral
non-occlusive arterial pathology are derived from avoidance of
major surgical procedures that typically require long hospital
stays and are associated with significant morbidity.5 However,
endovascular treatment methods are not currently seen as the
gold standard.1-8
In recent years, complications of percutaneous interventions
have been better defined. Some of these include displacement
of the stent, catheter embolisation as a result of breakage
or rupture, perforation, haematoma and dissection. Despite
complication rates as low as 1% in terms of outcome of death,
in a retrospective study by Motta et al. it was found that catheter
rupture, fracture or migration require an intervention as soon as
possible.6
The most common cause of catheter rupture is use of worn-
out equipment. In our case the reason for the complication was
that we probably forced the guide wire too hard at the level of the
abdominal aorta. The severity of acute complications requires
removal of the broken parts as soon as possible.6
Complications of percutaneous approaches have led to the
testing of different devices for removal of intravascular foreign
bodies,7 for example, balloon catheter, forceps, guide wire,
introducer and snare. Forceps and sheath are rigid and short; the
balloon catheter and guide wire are seldom used due to limited
space. In many cases of intravascular foreign body removal,
different types of snares are preferred.7,8 In a 12-year study by
Wolf et al., the snare loop initially produced an 87% success
rate for removal of intravascular foreign bodies; thereafter the
success rate was 96%, and surgically treated cases had only a 4%
success rate. 8
The use of endovascular procedures may be faster and safer
for the treatment of post-traumatic vascular lesions. Studies
have shown a low incidence of complications,8 however, definite
indications are not clear.
Conclusion
With rapid technological development and the appropriate use
of new devices, endovascular methods should be given priority
because of the short surgery time, less trauma, and safety of
the procedures in elective cases. For these reasons, we chose
endovascular treatment in our case instead of the surgical
option, despite endovascular treatment methods not currently
being seen as the gold standard.1-8
References
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3. , , . Brachial artery
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10.1177/1538574410377669. Epub 2010 Jul 30.
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10.1016/j.injury.2012.08.028. Epub 2012 Aug 22.
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, , et al. Endovascular techniques and
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10.1002/ccd.22074.
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, et al. Endovascular management of lost or misplaced
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Fig. 3. Broken catheter piece.