Case Report: EPD-assisted “Open Umbrella” retrieval of a migrated traumatic intravascular foreign body

Intravascular foreign bodies (IFBs) resulting from penetrating trauma pose significant clinical challenges due to their irregular geometry, thrombogenicity, and propensity for distal migration. While endovascular snare retrieval is the established standard for smooth, tubular iatrogenic objects, it often fails when fragments lie flush against the vessel wall. We report the case of a 71-year-old male who sustained a penetrating injury to the left femoral artery by a metallic fragment. During initial surgical repair at a local hospital, the fragment migrated distally. Computed tomography angiography localized the triangular foreign body within the superficial femoral artery. We utilized an “Open Umbrella” technique, repurposing a distal embolic protection device (EPD) as an active capture tool. This methodology facilitated successful retrieval while providing continuous distal perfusion and obligate protection against secondary embolization (“trash foot” phenomenon). The procedure adhered to the principles of Damage Control Interventional Radiology (DCIR), avoiding complex surgical re-exploration. Our experience highlights that EPD-assisted retrieval offers a bimodal advantage of high-probability capture and embolic prophylaxis. For successful extraction, we recommend the “2-Fr rule”—utilizing a retrieval sheath at least 2-Fr larger than the object's diameter. EPD-assisted retrieval should be considered a primary salvage or even a first-line strategy for complex traumatic IFBs.