Preface

Chapter 9 **Foreign Intravascular Object Embolization and Migration:**

and Stanislaw P. Stawicki

**VI** Contents

**Bullets, Catheters, Wires, Stents, Filters, and More 109** Thomas R. Wojda, Stephen D. Dingley, Samantha Wolfe, W. T. Hillman Terzian, Peter G. Thomas, Daniel Vazquez, Joan Sweeney

> The management of embolic complication of common medical problems represents a signifi‐ cant and ever-evolving medical challenge. The primary focus of this text is to discuss the spectrum of problems that can range from unusual embolic problems in a general popula‐ tion to the specific nuances of diagnosis and management of more commonly observed problems in specific patient populations.

> Clearly, the most commonly encountered medical problem that is associated with embolic complications is atrial fibrillation. The management of atrial fibrillation has changed dra‐ matically over the recent years due to the development of diagnostic risk assessment tools, safer and innovative anticoagulation options (i.e., novel anticoagulations), invasive thera‐ pies for the treatment of atrial fibrillation (i.e., surgical or catheter-based ablations), and in‐ terventions to reduce the risk of embolic complications (i.e., left atrial appendage ligation or closure devices) or the pathologic impact of such complications when they do occur. The management of atrial fibrillation has served as a paradigm for the management of other types of embolic issues. However, it is important to consider that there are a variety of medi‐ cal problems—including iatrogenic misadventures—that can cause embolic complications. Some of these problems are rare and unusual, and often there is little in terms of random‐ ized trials or extensive clinical literature to guide management. The goal of some of these chapters is to recognize the lack of a standardized approach to the diagnosis and manage‐ ment of some of the less common problems while highlighting some of the existing experi‐ ences, data, and options to help guide decision-making and therapy.

> Furthermore, it is also critical to recognize that unusual embolic complications can result from specific physiologic conditions—such as during and after pregnancy—or as a conse‐ quence of routinely performed procedures—such as orthopedic surgery. Because of patientspecific characteristics and comorbidities, the diagnosis and management options might be substantially different than a population as a whole. Concepts such as prevention, aware‐ ness, and early and aggressive treatment reflect the cornerstones to good outcomes. As such, this text will also address some of the unique and challenging aspects in dealing with these specific patient populations and their disease-specific problems.

> It is also important to recognize that the diagnosis and management of embolic complica‐ tions and the pathologic conditions that cause them is an extremely diverse and complex area of medicine. By no means is this text inclusive of all aspects of this challenging and evolving phenomenon, but rather it serves to highlight some unusual problems to help clini‐ cians better understand the broad depth and scope of embolic diseases—and how often the diagnosis and management is much more complex than just a single therapy, like anticoagu‐ lation. A common theme throughout this text is that sometimes, while controversial, inva‐

sive or surgical options should be considered early for acute or chronic embolic complications.

Probably the most important concept is that embolisms can often be a manifestation of a much more complex or serious medical condition. Without a doubt, such problems—espe‐ cially in terms of prevention, diagnosis, and management—require an integrated multidisci‐ plinary team to help coordinate care. As with many problems in medicine, such a coordinated team approach must consist of a full spectrum of disciplines and expertise fo‐ cused on the ability to assess and manage complex problems in a timely and efficient man‐ ner. As some of the chapters emphasize, prevention is crucial—especially in various highrisk patient populations. However, since embolisms can occur at any time—and they can present with immediate life or organ-threatening problems (such as neurologic events or limb-threatening ischemia)—dedicated response teams must be organized in advance and be able to respond immediately.

Embolisms, by definition, are pathologic and often associated with severe and potentially fatal complications. This text will hopefully serve as a guide to some of the more challenging and unusual patient populations and problems that occur when medical teams encounter embolic complications. The primary goal of this text is to emphasize the importance of a timely, efficient, and multidisciplinary approach to patient management to achieve optimal outcomes.

Thank you.

**Michael S. Firstenberg, MD, FACC** Director, Adult ECMO Program Associate Professor of Surgery and Integrative Medicine Northeast Ohio Medical Universities Department of Surgery (Cardiothoracic) Akron City Hospital—Summa Health System Akron, Ohio, USA
