Catheterization and Cardiovascular Diagnosis 28:332-334 (1993) Percutaneous Retrieval of a Deformed Guidewire by a Modified Snaring Technique Sumit Roy, MBBS, MD, R.V. Phadke, MBBS, DMRD, MD, Sunil Kumar, MBBS, MD, Harsh Rastogi, MBBS, MD, and S.S. Baijal, MBBS, MD An attempt to percutaneouslyremove a guidewire from the inferior vena cava was ham- pered by kinks developing in the wire during snaring. A modified technique was adopted that permitted its retrieval, obviating the need for a formal venotomy. Key words: catheterization complications, foreign body, intravascular zyxwvu G 1993 Wiley-Liss, Inc. INTRODUCTION zyxwvutsrqp Percutaneous retrieval techniques form an important part of the armamentarium of an interventional radiolo- gist or invasive cardiologist. Although procedural varia- tions abound, the published methods essentially involve the use of a snare, a basket, or a grasping device [l]. Snares are by far the easiest to employ and can be safely used at diverse sites. We report a procedural modifica- tion that may be used with advantage in selected cases. CASE REPORT zyxwvutsrq A middle-age male, suspected of having a hyperneph- roma in the right kidney, was referred for preoperative angiography. Since the venous phase of the selective arterial study was unsatisfactory, it was decided to pro- ceed with renal venography zyxwvutsr . Following left femoral venepuncture, a guidewire was placed in the vessel. Mo- mentarily distracted at this stage, the operator (S.R.) failed to ensure that the proximal end of the guidewire had emerged from the hub of the dilator before introduc- ing the sheath-dilator assembly into the vein. Immedi- ately the error was recognised, and the dilator with its overlying sheath carefully withdrawn, but the guidewire failed to come out in tandem. The skin incision was lengthened and the subcutaneous tissues carefully ex- plored without success. While compression was maintained on the left femoral vein to prevent central migration of the wire, a 8Fr vas- cular sheath was inserted in the right femoral vein. An improvised Cuny retrieval device with an angled loop [2], fashioned from a short thin-walled, nontapered 8Fr teflon catheter and a 0.021” guidewire, was introduced. The wire was snared and pulled, doubled up, into the right external iliac vein, where it snagged against the tip of the sheath (Fig. 1). Since larger sheaths proved to be zyxwvu 0 1993 Wiley-Liss, Inc. temporarily out of stock in the angiography laboratory, the wire was released, and the loop snare maneuvered along its length, until the flexible terminal segment was reached. Here it was again tightened and withdrawn from the femoral vein, bringing out the floppy end of the wire. Unexpectedly, the guidewire shaft wound itself pari passu into a complex configuration (Fig. 2), preventing the rest of the wire from coming out as well. A 7Fr dilator was introduced into the femoral vein over the exteriorised portion of the guidewire and passed until its progress was halted by the wire morphology. A steady pull was maintained on the floppy end, while the dilator was simultaneously pushed in with a rotatory motion. Slowly but surely, it negotiated the kinked segment. With the dilator held stationary, steady traction was ap- plied on the wire until its entire length emerged from the dilator (Figs. 3,4). The latter was then removed and hae- mostasis achieved by manual compression. DISCUSSION Textbook descriptions of percutaneous snaring of a linear foreign body envisage securely grasping a free end, prior to withdrawing it from the vasculature [l]. Alternatively, the main body of the catheter or guidewire fragment can be trapped and brought out doubled over through, or together with, the introducer sheath [3]. Nei- ther method was successful in our patient. Operative in- From the Department of Radiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India. Received May 27, 1992; revised and accepted August 10, 1992. Address reprint requests to Dr. Sumit Roy, Department of Radiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareli Road, Lucknow 226 001, India.