Retrieval of an incidentally found migrated temporary epicardial pacing wire in the superior mesenteric artery of an elderly male patient in the Northeastern United States years post heart transplant: a case report

Introduction: Temporary epicardial pacing wires (TEPWs) are utilized for arrhythmia management in postoperative cardiac surgery. TEPWs that cannot be removed are sometimes left in situ, which can lead to rare complications such as vessel stenosis and thrombosis. This case report describes the use of small biopsy forceps advanced to the superior mesenteric artery (SMA) through a steerable sheath to remove a partially endothelialized TEPW. Case Presentation: A 66-year-old man with a history of orthotopic heart transplantation presented for routine follow-up 2 years post-transplant. Imaging revealed a linear foreign object extending from the descending aorta into the SMA. The partially endothelialized object was successfully retrieved via percutaneous femoral access using an 8.5-Fr steerable sheath to advance endoscopic biopsy forceps, followed by a trilobed snare. The retrieved object measured 20 cm × 0.1 cm and was confirmed to be a retained TEPW. Post-procedural angiography showed no abnormalities, and the patient was discharged without complication. Clinical Discussion: Although a rare occurrence, there are no established clinical guidelines on the management or monitoring of retained TEPWs to avoid potential complications. In this report, the main concern was bowel ischemia, which urged object retrieval. Catheter snares are the preferred tools for intravascular foreign body retrieval. However, in this case, an uncommon approach involving a steerable sheath to advance endoscopic biopsy forceps into deep vasculature was successfully employed to retrieve the partially endothelialized wire. Conclusion: This case highlights an alternative retrieval technique for retained TEPWs and underscores the need for clinical guidelines to manage asymptomatic cases and prevent serious complications.