Unconventional retrieval of a guidewire fragment from the pulmonary district following retrograde access for chronic limb-threating ischemia

Intraprocedural endovascular device fracture and migration is an uncommon complication, with potential catastrophic outcomes. In a 75-year-old woman, retrograde puncture of the superficial femoral artery led to accidental femoral vein puncture and wire coating fragmentation. The fragment migrated up to a sublobar branch of the left pulmonary artery, and again to the right pulmonary artery during the first retrieval attempt. The final retrieval was performed by twisting three 0.014″ wires around the fragment, together with the support provided by the thromboaspiration Indigo-Penumbra catheter. The triple wire twisting technique supported by an aspiration catheter seems to be safe and effective for this serious pulmonary complication.