Percutaneous extraction of retained guidewire from a 22-year-old woman 5 years after atrial tachycardia ablation: A novel application of the hangman loop snare technique

Figure 1. A: Chest radiograph on presentation reveals the retained J-wire extending into the superior vena cava along the right edge of the vertebral column. B: Abdominal radiograph shows the termination of the retained wire in the femoral vein. C: Coronal computed tomography (CT) scan revealing the thoracic course of the retained J-tipped wire. Multiple sections of wire are free-floating within the vein. D: Sagittal-plane CT scan showing the same. E: Multiplanar reconstruction CT scan showing the same from a posterolateral oblique plane.

Figure 2. A hydrophilic wire loop (A) captured the retained guidewire near the level of the diaphragm. Post-retrieval venogram revealed no injury to the superior vena cava (B) or abdominal inferior vena cava (C). Narrowing of the right common femoral vein (D) was measured as 1.4 cm at the narrowest point. This reflects chronic endothelial thickening provoked by the retained guidewire.

Figure 3. An ideogram depicting the hangman loop snare technique for J-wire extraction in this case. 1: A hydrophilic wire (dashed line) is advanced via a reverse-curve guide catheter (orange) to the retained wire (solid black line). 2: An endovascular snare (gold) is advanced through the guide catheter and captures the distal end of the hydrophilic wire. 3: The endovascular snare is withdrawn into the guide catheter. 4: The reverse-curve guide catheter is withdrawn and straightened. 5: A hangman loop has captured the object. 6: The catheter is subtracted along the free segment of wire. 7: The snare is dragged along the adhered segment to free it from the vascular adhesions (gray blotch). 8: The snare is dragged to the proximal end of the wire, freeing the wire. 9: The snare is subtracted into the catheter, pulling the wire within. 10: The wire is removed through the catheter.