[MO-19] Guidewire Fracture, Retrieval of the fragment, and a following Occlusion of the Artery
An 80-year-old woman, with limited systemic sclerosis and unhealed left foot ulcer, had the anterior tibial artery and posterior tibial artery (PTA) occlusion. Using a 3.3Fr guiding catheter and a 0.014-inch guidewire, we tried to treat the PTA occlusion.
Although the guidewire passed through the proximal lesion of the occluded PTA without any difficulty, it was broken apart at the distal portion in the PTA because of a calcified and flexuous lesion at the ankle joint level of the PTA.
Twisting wire technique is known as a simple and effective technique to retrieve fractured guide wire fragments. By tangling with two additional 0.014-inch guidewires, we were able to catch and pull a fragment up to the proximal portion of the PTA, and successfully retrieve the fragment out of the body.
At the next moment, she complained of advanced foot pain. The following angiography revealed that the ostium of the peroneal artery (PA) was occluded. Passing a guidewire through the occluded PA and dilating with a 2.0x40 mm balloon at the occluded lesion, we could obtain a recanalization of the PA and disappearance of acute foot pain.
We estimated that a thrombus in the occluded PTA was also pulled up together by the procedure and made the PA occluded.
While twisting wire technique would be effective for retrieval of a broken fragment of a guidewire, we should keep in mind this potential risk when using it during endovascular intervention, especially in occluded peripheral arteries.
Although the guidewire passed through the proximal lesion of the occluded PTA without any difficulty, it was broken apart at the distal portion in the PTA because of a calcified and flexuous lesion at the ankle joint level of the PTA.
Twisting wire technique is known as a simple and effective technique to retrieve fractured guide wire fragments. By tangling with two additional 0.014-inch guidewires, we were able to catch and pull a fragment up to the proximal portion of the PTA, and successfully retrieve the fragment out of the body.
At the next moment, she complained of advanced foot pain. The following angiography revealed that the ostium of the peroneal artery (PA) was occluded. Passing a guidewire through the occluded PA and dilating with a 2.0x40 mm balloon at the occluded lesion, we could obtain a recanalization of the PA and disappearance of acute foot pain.
We estimated that a thrombus in the occluded PTA was also pulled up together by the procedure and made the PA occluded.
While twisting wire technique would be effective for retrieval of a broken fragment of a guidewire, we should keep in mind this potential risk when using it during endovascular intervention, especially in occluded peripheral arteries.