Endovascular Retrieval Of Pulmonary Artery Wire Fragment
Dalila White, MD, Charudatta Bavare, MD, MPH.
Houston Methodist Hospital, Houston, TX, USA.
This video demonstrates endovascular retrieval of a 7 cm wire fragment in the left lower segmental pulmonary artery. The patient is a 45 year old female who had previously undergone difficult Port-a-Cath placement. Postoperatively, on routine imaging, CT chest revealed a 7 cm wire fragment in the left lower segmental pulmonary artery. At that time the patient was asymptomatic but desired to have the fragment removed. Seen here on the axial cuts, there is no evidence of extravasation or pulmonary embolism. Therefore the plan was to take the patient to the operating room for retrieval of the 7 cm wire fragment. We accessed the right common femoral vein under ultrasound guidance. This was done with a minstick needle, followed by the wire and a micropuncture sheath. We then upsized to a 6 Fr sheath over wire. A soft wire was introduced into the main pulmonary artery which was exchanged for an Amplatz super stiff wire over a catheter. We then introduced an 8 Fr x 90 cm sheath in to the main pulmonary artery. Pulmonary arteriogram was performed which showed filling of the main pulmonary branches as well as the distal branches without any active extravasation. We also confirmed the 7 cm wire fragment in the left lower segmental pulmonary artery. We then carefully introduced our wire into the left lower segmental pulmonary artery. This is followed by advancement of the En Snare catheter into the left lower segmental pulmonary artery as well. Repeat angiogram confirmed placement of our catheter in the left lower segmental pulmonary artery. Next we advanced our En Snare into the left lower segmental pulmonary artery. The wire fragment was then captured in the En Snare and withdrawn into the sheath as shown here. Once the wire fragment was retrieved and externalized, repeat pulmonary angiogram showed filling of the main pulmonary artery and its distal branches without extravasation, and successful retrieval of the wire fragment. The wire fragment is seen here. This concludes our demonstration of an endovascular retrieval of a 7 cm wire fragment from the left lower segmental pulmonary artery.
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