Rotating SIM Technique—A Novel Technique for Retrieval of Retained Guidewire from Internal Iliac Vein

Abstract

Abstract As the number of endovascular procedures is increasing, the incidence of intravascular foreign body (IFB) is also on a rising trend. Broken catheter fragments or leftover guidewires are common IFB. These foreign bodies can embolize, causing injury to vital structures or may cause vascular thrombosis. Standard snare retrieval techniques may fail when the accessible end of the foreign body lies deep within a small or acutely angled branch vessel. We describe a branch vein-specific Simmons (SIM)-based rotational repositioning variant that enables the retrieval of a retained guidewire impacted in the internal iliac vein. A 39-year-old male patient with chronic kidney disease presented with a retained guidewire in the venous system after placement of a dialysis catheter in the right internal jugular vein. The J-tip of the guidewire was lodged deep into the right internal iliac vein, and retrieval of the guidewire by grasping its tip and snaring using a standard loop snare was not feasible. The proximal end was also not thought to be safely retrievable by simply pulling out the catheter because it could not be easily accessed for manual extraction. Taking out the catheter could have caused the guidewire to further migrate and loss of the only functioning dialysis access. So, a reverse curved catheter (SIM1) was used to engage the guidewire in its primary curve. After engagement, the catheter-guidewire combination was pushed up, placing the guidewire in the right common iliac vein, from where it was snared out. Our case describes a practical use of a reverse curved catheter (SIM1) to engage and displace intravascular retained foreign body lodged deep in the internal iliac vein. We propose that this technique is an easy and effective technique to reposition foreign bodies from anatomically difficult regions to more favorable locations from where snaring can be easily performed.