Search and Rescue: A Case Report and Discussion of Iatrogenic Intravascular Foreign Bodies.

The following case report demonstrates an unusual case of a patient with multiple intravascular iatrogenic foreign bodies. An inferior vena cava filter was identified in the abdominal aorta, and multiple hydrophilic wire fragments were found in the pulmonary circulation. After describing the management of this patient, we discuss how radiologists can best distinguish between various intravascular iatrogenic foreign bodies. Determining the type of catheter or wire within the patient can not only establish the chronicity of the finding, but can determine whether or not endovascular retrieval is recommended, and by what method. It is of the utmost importance that providers be able to distinguish between various intravascular devices in order to prevent ongoing or further harm to the patient.

Reteplase infusion in the treatment of acute lower extremity occlusions.

PURPOSE: Reteplase, a recombinant tissue plasminogen activator, has been used in the treatment of acute coronary occlusion. Experience is accumulating regarding its use in the treatment of peripheral vascular disease. Increased experience with this thrombolytic agent may show that it can be an appropriate alternative agent to currently employed plasminogen activators. MATERIALS AND METHODS: Over the course of six months, reteplase was used to treat 18 patients with peripheral arterial occlusions, confined to the lower extremities. The agent was infused via "pulse-spray" catheters. Fifteen patients were started on 0.5 U/h. Concurrent heparin therapy was used at 500 U/h in 16 of 18 patients. RESULTS: The average total dose of reteplase infused was 13.3 units. It ranged from 6.2 to 41.5 units. The average duration of infusion was 26.9 hours with a range of 12-44 hours. Clinical success, defined as restoration of sufficient patency to reestablish limb function and resolution of pain in the symptomatic extremity was 89% (16 out of 18). Hemorrhagic complications occurred in five patients and were major in one patient (5%). No patient experienced intracranial hemorrhage. CONCLUSION: Increased experience with the use of reteplase in the treatment of acute lower extremity occlusions is accumulating. The safety and efficacy profile in our group appears satisfactory and compares to other studies. However, definite conclusions must await the results of controlled comparisons of different reteplase infusion regimens and controlled comparison to other thrombolytic agents.