[MO-17] Successful bailout EVT to retrieve the broken tube of the guide extension support catheter remained in the common iliac artery
It is rare that the broken tube of the guide extension support catheter (GESC) remains in the artery during endovascular therapy (EVT). 71-year-old female with end-stage renal disease on hemodialysis was diagnosed with arteriosclerosis obliterans. Peripheral angiography revealed left superficial femoral artery (SFA) and popliteal artery (POPA) had subtotal occlusions with heavy calcified plaque. EVT was performed to them by crossover approach with 6Fr guide-sheath inserted via the right common femoral artery (CFA). The 0.014-inch guidewire was penetrated to lesions of SFA and POPA. After 1.5mm balloon dilatation, 3.0mm balloon wasn’t crossed the POPA lesion. So the GESC was promoted to the SFA for the balloon delivery. Though we repeatedly pushed the GESC with balloon, the GESC wasn’t advanced at the middle SFA. While we tried to pull the GESC to 6Fr guide-sheath, we felt strong resistance. After the resistance was suddenly disappeared, we could pull the GESC to the outside of body. But we found out that there was the only shaft of GESC. The fluoroscope image revealed there was the broken tube of the GESC in the left external iliac artery. Because there were the guidewire and 3.0mm balloon in the tube, we tried to return the tube into 6Fr guide-sheath with inflating 3.0mm balloon. But we couldn’t return the tube because the distal end of tube was expanded like petals. So we inserted 7Fr sheath via left CFA which was contralateral side of 6Fr guide-sheath. After we captured the top of balloon and guidewire shaft with a snare via 7Fr sheath, we could pull them into 7Fr sheath. In the same time of pulling them, the top of tube was advanced into 7Fr sheath. We pinched both the tube and 7Fr sheath with fingers, then we could pull the broken tube to the outside of body.