104 - "Successful Use of ONE Snare® Endovascular Snare System in Retrieval of an Intravascular Foreign Body"
Nana Ohene-Baah, MD – Attending Physician, Interventional Radiology, University of Louisville Hospital; Wilfred Furtado, BA – Medical Student, University of Louisville School of Medicine
Purpose: Guidewires are a useful tool that allow for percutaneous introduction of placement catheters and various interventional devices. However, potential complications can result from guidewire use. One particular complication involves kinking, looping, or knotting of the guidewire, which typically occurs when persistent forward force is applied against a fixed resistance. Such complications can become further convoluted by entanglement of the guidewire around an existing intravascular device, creating a risk for potential foreign body. Here we present a case detailing the consideration, approach, and technique used to retrieve a guidewire looped around a right subclavian PICC line using the ONE Snare® Endovascular Snare System.
Material and Methods: Retrospective chart review was performed with special attention to medical interventions, imaging results, and overall clinical course.
Results: A 27-year-old female presented for exchange of a right subclavian PICC line with a Hickman catheter. Following trans-jugular advancement of a guidewire, fluoroscopy revealed the guidewire to be looped around the right subclavian PICC line. Given the location of the entanglement, a right common femoral vein approach was utilized to simplify access. Successful retrieval was accomplished by use of a Merit Medical ONE Snare® Endovascular Snare System, with the entangled PICC and guidewire being removed without further complication.
Conclusions: Entanglement of a guidewire around an existing intravascular device is a potentially serious complication that can create risk for intravascular foreign body. Appropriate suspicion and prompt recognition with fluoroscopic guidance is required to accurately recognize and treat this complication. Establishing a direct and simple retrieval approach is essential, both to minimize further complications and to ensure for successful retrieval. This case details successful use of the Merit Medical ONE Snare® Endovascular Snare System in retrieval of a guidewire looped around a right subclavian PICC line.