This case involves a male patient in South Dakota with a medical history of high blood pressure, obesity, coronary artery disease and previous stents who presented to the emergency department with complaints of chest pain for which he was evaluated and scheduled for surgery to open up blocked arteries and have a stent placement. As the procedure concluded and the guidewire was retracted, the end of it became detached and remained lodged between the surgical opening and the fat underneath the skin. The treating physician referred the patient to vascular surgery to assess the risk-benefits of leaving this foreign body. After evaluation of the site it was determined that the foreign body posed no risk if left since it was not intravascular. An ultrasound was ordered the following week localizing the retained portion of the catheter to the femoral artery, and was removed the subsequent week, as the patient began to present signs of inflammation and pain. After 5 days, the patient began to suffer from increased pain in his leg.
Question(s) For Expert Witness
1. Do you have experience managing patients with a similar constellation of concomitant conditions?
2. Have you ever encountered such complications secondary to iatrogenic sources? Please elaborate on your experience with retained foreign bodies intra- and extravascular?
3. Have you ever trained other clinicians, lectured or published on the subject described herein?
Expert Witness Response E-001075
I am a vascular surgeon and I have a clinical practice in vascular surgery where we often encounter patients like the one described, with multiple comorbidities. We cover the entire breadth of vascular disease and routinely care for patients undergoing endovascular procedures. I am also a faculty member and training program director at a top 5 medical school. Foreign body retention is a rare complication with endovascular procedures and can often be avoided with careful procedural technique. As most interventions are done with a sheath in place, it is very unusual to have portions of a guidewire left behind in the subcutaneous tissue. Most retained foreign bodies should be removed if possible in order to avoid late complications. The decision to proceed (so called "risk-benefit") is individualized to the patient's overall health and clinical situation.
About the author
Kana Prasertchoang
Kana Prasertchoang is a content writer and strategist with experience writing for legal services and civic engagement.
