1
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Quaretti P, Corti R, D’Agostino AM, Cionfoli N. U-bent Viabahn stent graft in the main left pulmonary artery in a hemodialysis patient after asymptomatic migration: Percutaneous removal and technical considerations. J Vasc Access 2024; 25:1666-1671. [PMID: 37439244 PMCID: PMC11402257 DOI: 10.1177/11297298231158545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 02/02/2023] [Indexed: 07/14/2023] Open
Abstract
BACKGROUND Stent grafts (SG) have gained the highest level of evidence for superior management over angioplasty of arteriovenous graft (AVG) venous outflow stenosis, which increases their use in hemodialysis patients. Migration to the heart and lungs is the most feared complication of SG of the venous system. METHOD We present a previously unreported case of asymptomatic migration of a 10-cm-long Viabahn lodged in a U-shaped configuration in the main left pulmonary artery after AVG intervention in a 50 year old male hemodialysis patient. RESULTS Through a single femoral access percutaneous retrieval of migrated SG was accomplished. Technique of coaxial buddy snaring technique is described. CONCLUSION Our technique may expand the endovascular likelihood of successful stent removal.
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Affiliation(s)
- Pietro Quaretti
- Interventional Radiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Riccardo Corti
- Interventional Radiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | | | - Nicola Cionfoli
- Interventional Radiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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2
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Bai H, Kibrik P, Shaydakov ME, Singh M, Ting W. Indications, technical aspects, and outcomes of stent placement in chronic iliofemoral venous obstruction. J Vasc Surg Venous Lymphat Disord 2024; 12:101904. [PMID: 38759753 DOI: 10.1016/j.jvsv.2024.101904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 04/13/2024] [Accepted: 04/22/2024] [Indexed: 05/19/2024]
Abstract
BACKGROUND Iliofemoral venous stent placement (IVS) has evolved to a well-established endovascular treatment modality for chronic iliofemoral venous obstruction (CIVO). Dedicated venous stents gained approval from the US Food and Drug Administration in 2019 and solidified IVS as a defined intervention with clear indications, contraindications, risks, benefits, and procedural management principles. This review focuses on the indications, technical aspects and outcomes of stenting for CIVO. Other aspects pertaining to IVS are covered in other articles that are a part of this series. METHODS This study conducted a literature search limited to English articles. Three search strategies were used, and references were managed in Covidence software. Four investigators screened and evaluated articles independently, excluding meta-analyses, clinical trial protocols, and nonrelevant studies. Eligible studies, focused on clinical outcomes and stent patencies, underwent thorough review. RESULTS The literature search yielded 1704 studies, with 147 meeting eligibility criteria after screening and evaluation. Exclusions were based on duplicates, irrelevant content, and noniliac vein stent placement. CONCLUSIONS Successful IVS for CIVO relies on meticulous patient selection, consistent use of intravascular ultrasound examination during procedures and attention to the technical details of IVS.
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Affiliation(s)
- Halbert Bai
- Division of Vascular Surgery, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Pavel Kibrik
- Division of Vascular Surgery, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Maxim E Shaydakov
- Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburg, PA
| | - Mandeep Singh
- Division of Vascular Surgery, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Windsor Ting
- Division of Vascular Surgery, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY.
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3
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Wu Z, Zhou Z, Bian C, Guo L, Tong Z, Guo J, Qi L, Cui S, Zhang C, Chen Y, Huang W, Gu Y. In vivo evaluation of safety and performance of a tapered nitinol venous stent with inclined proximal end in an ovine iliac venous model. Sci Rep 2024; 14:7669. [PMID: 38561485 PMCID: PMC10984921 DOI: 10.1038/s41598-024-58237-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 03/26/2024] [Indexed: 04/04/2024] Open
Abstract
A tapered stent with inclined proximal end is designed for fitting the iliac anatomically. The aim of the present study was to evaluate the safety and performance of the new stent in ovine left iliac veins. The experiment was performed in 30 adult sheep, and one nitinol-based VENA-BT® iliac venous stent (KYD stent) was implanted into each animal's left common iliac vein. Follow-up in all sheep consisted of angiographic, macroscopic, and microscopic examinations at Day 0 (< 24 h), Day 30, Day 90, Day 180 and Day 360 post-stenting (six animals per each time-point). 30 healthy ~ 50 kg sheep were included in this study and randomly divided into five groups according to the follow-up timepoint. All stents were implanted successfully into the left ovine common iliac vein. No significant migration occurred at follow-up. There is no statistically significant difference between the groups (p > 0.05), indicating no serious lumen loss occurred during the follow-up period. Common iliac venous pressure was further measured and the results further indicated the lumen patency at follow-up. Histological examinations indicated that no vessel injury and wall rupture, stent damage, and luminal thrombus occurred. There was moderate inflammatory cell infiltration around the stent in Day-0 and Day-30 groups with the average inflammation score of 2.278 and 2.167, respectively. The inflammatory reaction was significantly reduced in Day-90, Day-180 and Day-360 groups and the average inflammation scores were 0.9444 (p < 0.001, Day-90 vs Day-0), 1.167 (p < 0.001, Day-180 vs Day-0) and 0.667 (p < 0.001, Day-90 vs Day-0), respectively. The microscopic examinations found that the stents were well covered by endothelial cells in all follow-up time points. The results suggested that the KYD stent is feasible and safe in animal model. Future clinical studies may be required to further evaluate its safety and efficacy.
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Affiliation(s)
- Zhongjian Wu
- Department of Vascular Surgery, Xuanwu Hospital, Capital Medical University, 45 Changchun Street, Xicheng District, Beijing, 100053, China
| | - Zhengtong Zhou
- Vascular Surgery, The First Affiliated Hospital of Shandong First Medical University, Jinan, China
| | - Chunjing Bian
- General Surgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Lianrui Guo
- Department of Vascular Surgery, Xuanwu Hospital, Capital Medical University, 45 Changchun Street, Xicheng District, Beijing, 100053, China
| | - Zhu Tong
- Department of Vascular Surgery, Xuanwu Hospital, Capital Medical University, 45 Changchun Street, Xicheng District, Beijing, 100053, China
| | - Jianming Guo
- Department of Vascular Surgery, Xuanwu Hospital, Capital Medical University, 45 Changchun Street, Xicheng District, Beijing, 100053, China
| | - Lixing Qi
- Department of Vascular Surgery, Xuanwu Hospital, Capital Medical University, 45 Changchun Street, Xicheng District, Beijing, 100053, China
| | - Shijun Cui
- Department of Vascular Surgery, Xuanwu Hospital, Capital Medical University, 45 Changchun Street, Xicheng District, Beijing, 100053, China
| | - Chengchao Zhang
- Department of Vascular Surgery, Xuanwu Hospital, Capital Medical University, 45 Changchun Street, Xicheng District, Beijing, 100053, China
| | - Yilong Chen
- ShenZhen KYD Biomedical Technology Co. Ltd, Guangzhou, China
| | - Wei Huang
- ShenZhen KYD Biomedical Technology Co. Ltd, Guangzhou, China
| | - Yongquan Gu
- Department of Vascular Surgery, Xuanwu Hospital, Capital Medical University, 45 Changchun Street, Xicheng District, Beijing, 100053, China.
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4
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Wei W, Zhao Q, Liu C, Yang L, Li J, Fu P, Zhao Y, Cui T. Stents migration into right atrium from severely calcified superior vena cava in a hemodialysis patient. Heliyon 2024; 10:e23621. [PMID: 38173496 PMCID: PMC10761771 DOI: 10.1016/j.heliyon.2023.e23621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Revised: 12/07/2023] [Accepted: 12/08/2023] [Indexed: 01/05/2024] Open
Abstract
Vascular calcification is common among hemodialysis patients. In this report, we presented a case of superior vena cava (SVC) stent migration during endovascular angioplasty in a 50-year-old female hemodialysis patient with severe SVC calcification. The stent migration was refractory to the deployment of a second anchor stent, which shortly resulted in pericardium tamponade and was successfully rescued by emergent thoracotomy. The potential role of vascular calcification as a risk factor to stent migration was discussed. Patients with severe vascular calcification receiving endovascular angioplasty might need a careful risk screening for stent migration.
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Affiliation(s)
- Wei Wei
- Division of Nephrology and Kidney Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Qiuyan Zhao
- Outpatient Department, West China Hospital of Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
| | - Caihong Liu
- Division of Nephrology and Kidney Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Letian Yang
- Division of Nephrology and Kidney Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Jian Li
- Division of Nephrology and Kidney Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Ping Fu
- Division of Nephrology and Kidney Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Yuliang Zhao
- Division of Nephrology and Kidney Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Tianlei Cui
- Division of Nephrology and Kidney Research Institute, West China Hospital, Sichuan University, Chengdu, China
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5
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Kim SH, Samuel M, Makramalla A. Viatorr Stent Migration and Retrieval during Transjugular Intrahepatic Portosystemic Shunt Revision. Semin Intervent Radiol 2023; 40:269-273. [PMID: 37484444 PMCID: PMC10359121 DOI: 10.1055/s-0043-1769772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/25/2023]
Abstract
Transjugular intrahepatic portosystemic shunt (TIPS) is an important interventional option for the treatment of complications related to cirrhosis and portal hypertension. Emergent TIPS placement can be a life-saving measure in patients with uncontrolled variceal hemorrhage. After TIPS placement, patients may benefit from additional interventions for clinical optimization including stent dilation, stent extension, and embolization of varices. Here, we describe a case of emergent TIPS placement and revision which resulted in TIPS stent migration requiring stent removal and replacement. We discuss our technique and review previously reported methods for the management of migrated TIPS stents.
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Affiliation(s)
- Stephanie H. Kim
- Division of Vascular and Interventional Radiology, Department of Radiology, University of Cincinnati, Cincinnati, Ohio
| | - Michael Samuel
- Division of Vascular and Interventional Radiology, Department of Radiology, University of Cincinnati, Cincinnati, Ohio
| | - Abouelmagd Makramalla
- Division of Vascular and Interventional Radiology, Department of Radiology, University of Cincinnati, Cincinnati, Ohio
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6
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Quencer KB. Superior Vena Cava Syndrome: Etiologies, Manifestations, and Treatments. Semin Intervent Radiol 2022; 39:292-303. [PMID: 36062219 PMCID: PMC9433155 DOI: 10.1055/s-0042-1753480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Superior vena cava (SVC) obstruction, whether from benign or malignant causes, results in a variety of symptoms. It is a potential medical emergency when cerebral or laryngeal edema occurs. Endovascular therapy is the treatment of choice for patients in need of emergent relief of symptoms. This article will provide a review of SVC syndrome with a focus on endovascular treatment techniques.
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Affiliation(s)
- Keith B. Quencer
- Dotter Interventional Institute, Oregon Health and Science University, Portland, Oregon
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7
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Hosny Sayed DM, Salem DM, Desai KR, O'Sullivan GJ, Black SA. A review of the incidence, outcome and management of venous stent migration. J Vasc Surg Venous Lymphat Disord 2022; 10:482-490. [PMID: 35026448 DOI: 10.1016/j.jvsv.2021.07.015] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 07/22/2021] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Percutaneous endovenous stenting has emerged during the last decade as the primary method of treating symptomatic venous outflow obstruction. A recognised complication of venous stenting is stent migration. The aim of this systematic review was to identify the number of cases reported in the published literature describing stent migration, to recognise risk factors that may be associated with this complication, and outcomes following migration. METHODS A review was conducted following MOOSE and PRIMSA guidelines and registered on PROSPERO. MEDLINE, EMBASE, and PubMed databases and key references were searched using specified keywords. All relevant data for primary procedure and subsequent presentation with stent migration was retrieved. Data was assessed as too low quality to allow for statistical analysis. RESULTS Between 1994 and 2020, 31 articles were identified comprised of 29 case reports and 2 case series providing data for 54 events of venous stent migration with 47/54 providing some data for stent used. Mean age of patients in who migration occurred was 50 years (range 19-88) and 57.6% (n=30) were male. Most reported cases were 60mm or less in length (38/46, 82.6%) and only 3 of the reports were stents greater than 14mm in diameter (3/47, 3.6%). None of the papers reported migration of stents of more than 100mm in length. In 85% of the migrated stent events, retrieval was attempted with 56% via an endovascular approach. The immediate outcome was satisfactory in 100% of the reported attempts whether by endovascular or open surgical approaches. CONCLUSIONS This literature review would suggest that the risk of migration is rare but may be underreported. The majority of reported cases are shorter and smaller diameter stents. The paucity of published data and the short term follow up provided suggest more formal data collection would provide a truer reflection of incidence however clear strategies to avoid migration need to be followed to prevent this complication from occurring.
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Affiliation(s)
- Dr Mohamed Hosny Sayed
- Department of Vascular Surgery, Level 1 North Wing Guys & St Thomas' NHS Foundation Trust, St Thomas' Hospital, Westminster Bridge Rd, London, SE1 7EH
| | - Dr Murtaza Salem
- Department of Vascular Surgery, Level 1 North Wing Guys & St Thomas' NHS Foundation Trust, St Thomas' Hospital, Westminster Bridge Rd, London, SE1 7EH
| | - Kush R Desai
- Department of Radiology, Northwestern University Feinberg School of Medicine, 676 N. St. Clair, Suite 800, Chicago, IL, 60611, USA
| | | | - Stephen A Black
- Department of Vascular Surgery, Level 1 North Wing Guys & St Thomas' NHS Foundation Trust, St Thomas' Hospital, Westminster Bridge Rd, London, SE1 7EH.
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8
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Chen B, Lai Q, Fedally S, Wan Z. Migration of covered stents in thoracic central vein obstruction procedures in patients with hemodialysis: Case report and literature review. Front Cardiovasc Med 2022; 9:954443. [PMID: 35966538 PMCID: PMC9363624 DOI: 10.3389/fcvm.2022.954443] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 07/04/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE The objective of the study is to present a case of hemodialysis in which the covered stent that had migrated into the right ventricle was retrieved by exploratory thoracotomy, and to review the literature on the diagnosis and treatment of stent migration in thoracic central vein obstruction (TCVO) procedures for hemodialysis patients. METHOD A systematic search of the PubMed database was performed to identify clinical presentations, imaging strategies, stent types, and treatment modalities for stent migration in hemodialysis patients. RESULTS A total of 14 case reports on stent migration in TCVO procedures for hemodialysis patients were included and analyzed. Ten cases included migration to the cardiac chambers and the remainder migration to the pulmonary artery. The common symptoms of stent migration in TCVO procedures are reported to be chest pain and dyspnea, while three of the cases studied involved no symptoms. Echocardiography, chest X-ray, and computed tomography are the commonly used methods for the diagnosis of stent migration and identification of the precise positioning of the stent. Stent migration to the right subclavian or innominate veins was the most prevalent case (seven cases). All were bare stents. Seven cases involved retrieval by interventional surgery, while four cases involved retrieval by open heart surgery. However, there were three cases in which the "wait-and-see" approach was adopted since the patients were asymptomatic. CONCLUSIONS Stent migration in TCVO procedures is a rare but extremely serious complication. The causes are not fully understood. The current treatment strategies include interventional surgery, open heart surgery, and the "wait-and-see" approach.
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Affiliation(s)
- Bo Chen
- Department of Ultrasonography, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qiquan Lai
- Department of Nephrology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Swalay Fedally
- Department of Nephrology, SSRN Hospital, Mauritius, Mauritius
| | - Ziming Wan
- Department of Nephrology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
- *Correspondence: Ziming Wan
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9
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Badesha AS, Siddiqui MM, Bains BRS, Bains PRS, Khan T. A systematic review on the incidence of stent migration in the treatment of acute and chronic iliofemoral disease using dedicated venous stents. Ann Vasc Surg 2022; 83:328-348. [DOI: 10.1016/j.avsg.2021.12.084] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 12/29/2021] [Accepted: 12/31/2021] [Indexed: 12/20/2022]
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10
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Haddad PG, Mohamed A, Peden EK. Novel technique of stent retrieval after migration to the right heart. J Vasc Surg Cases Innov Tech 2021; 7:781-784. [PMID: 34825120 PMCID: PMC8604739 DOI: 10.1016/j.jvscit.2021.09.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 09/12/2021] [Indexed: 11/06/2022] Open
Abstract
Central venous obstruction in the symptomatic patient is often treated with endovascular stenting. A rare, but serious, complication of this treatment is migration of the stent from the original site of deployment. Treatment of this complication requires either open or endovascular retrieval of the displaced stent. To treat a rare, but potentially devastating, complication, we have presented an effective endovascular method for migrated stent retrieval using a combination of a large bore sheath, balloon, and snare.
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Affiliation(s)
- Paul G. Haddad
- Department of Cardiovascular Surgery, Houston Methodist Hospital, Houston, Tex
| | - Ahmed Mohamed
- Department of Cardiovascular Surgery, Houston Methodist Hospital, Houston, Tex
| | - Eric K. Peden
- Department of Cardiovascular Surgery, Houston Methodist Hospital, Houston, Tex
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11
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Coe TM, Tanaka M, Bethea ED, D'Alessandro DA, Kimura S, Yeh H, Markmann JF. Liver transplantation with suprahepatic caval anastomosis including inferior vena cava stent. TRANSPLANTATION REPORTS 2021; 5. [PMID: 34485756 DOI: 10.1016/j.tpr.2020.100062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Budd Chiari syndrome (BCS) results from hepatic outflow obstruction. Endovascular management to restore venous patency, including inferior vena cava (IVC) angioplasty with stenting, and transjugular intrahepatic shunt (TIPS) placement to decompress liver congestion, have become standard of care. Herein, we describe a patient with BCS requiring liver transplantation and the surgical technique of suprahepatic IVC anastomosis including thoracic extension of an IVC stent with a review of the relevant literature. A 29-year-old female with BCS due to polycythemia vera, who had been previously managed with TIPS and IVC stent placement, was taken for liver transplantation. Preoperative imaging confirmed stent extension into the thoracic IVC and the stent was unable to be removed intraoperatively. The thoracic IVC was clamped through the diaphragm at the level of the right atrium and the stent was left in place and incorporated within the suprahepatic anastomosis with good vascular outcome at one year follow up. Diligent preoperative preparation is essential with adequate imaging and cardiac surgical consultation in patients with malpositioned stents. Review of the literature shows four cases in which performing the suprahepatic anastomosis including an embedded stent is a viable alternative that allows for avoidance of a thoracotomy.
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Affiliation(s)
- Taylor M Coe
- Division of Transplantation, Department of Surgery, Massachusetts General Hospital, Boston, MA, United States.,Harvard Medical School, Boston, MA, United States
| | - Mari Tanaka
- Harvard Medical School, Boston, MA, United States.,Department of Radiology, Massachusetts General Hospital, Boston, MA, United States
| | - Emily D Bethea
- Harvard Medical School, Boston, MA, United States.,Division of Gastroenterology, Department of Surgery, Massachusetts General Hospital, Boston, MA, United States
| | - David A D'Alessandro
- Harvard Medical School, Boston, MA, United States.,Division of Cardiac Surgery, Department of Surgery, Massachusetts General Hospital, Boston, MA, United States
| | - Shoko Kimura
- Division of Transplantation, Department of Surgery, Massachusetts General Hospital, Boston, MA, United States.,Harvard Medical School, Boston, MA, United States
| | - Heidi Yeh
- Division of Transplantation, Department of Surgery, Massachusetts General Hospital, Boston, MA, United States.,Harvard Medical School, Boston, MA, United States
| | - James F Markmann
- Division of Transplantation, Department of Surgery, Massachusetts General Hospital, Boston, MA, United States.,Harvard Medical School, Boston, MA, United States
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12
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Nishan B, Pavan BK, Mamata SH, Anand V. Subclavian arterial stent migration from technical error and effective strategic bail out. INDIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY 2021. [DOI: 10.4103/ijves.ijves_62_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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13
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Akay E, Işık O, Engin AY, Çakır V. Stage 1 hybrid palliation of hypoplastic left heart syndrome: an initial experience in pulmonary trunk approach, procedural modifications, and complication management. Turk J Med Sci 2019; 49:1374-1380. [PMID: 31549495 PMCID: PMC7018386 DOI: 10.3906/sag-1903-143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 06/22/2019] [Indexed: 11/07/2022] Open
Abstract
Background/aim Hypoplastic left heart syndrome (HLHS) is a rare pathology with a very high mortality rate. The present study aimed to share our initial experience with the ductus arteriosus stenting procedure using the pulmonary trunk approach in the treatment of HLHS, as well as provide some technical suggestions and discuss complications and their management. Materials and methods The medical records of 9 neonates (age range: 1–8 days) with HLHS, who were operated on within a 12-month period, were reviewed retrospectively. Preprocedural planning was performed by computed tomography angiography and echocardiography. The operations were performed in a hybrid surgery room by interventional radiologists and pediatric vascular surgeons. Balloon-expandable stents were used in all of the operations. Results All operations were successfully completed without any intraoperative mortality. All intraoperative complications were managed successfully during the stenting procedure. Conclusion Stage 1 hybrid palliation for HLHS is a safe and effective procedure when several key points are kept in mind.
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Affiliation(s)
- Emrah Akay
- Department of Radiology, Faculty of Medicine, Balıkesir University, Balıkesir, Turkey
| | - Onur Işık
- Department of Pediatric Cardiovascular Surgery, Tepecik Training and Research Hospital, İzmir, Turkey
| | - Ayşen Yaprak Engin
- Department of Cardiovascular Surgery, Tepecik Training and Research Hospital, İzmir, Turkey
| | - Volkan Çakır
- Department of Radiology, Faculty of Medicine, Kâtip Çelebi University, İzmir, Turkey
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14
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Bouziane Z, Malikov S, Bracard S, Fouilhé L, Berger L, Settembre N. Endovascular Treatment of Aortic Arch Vessel Stent Migration: Three Case Reports. Ann Vasc Surg 2019; 59:313.e11-313.e17. [DOI: 10.1016/j.avsg.2019.01.029] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 01/16/2019] [Accepted: 01/19/2019] [Indexed: 11/25/2022]
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15
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Blais JM, Letourneau M, Hinojos A, Sandy R, Gray T, Miller T. I'll Stay a While: An Unusual Case of a Chronic Migrated Upper Extremity Endovascular Stent. CASE 2019; 3:100-102. [PMID: 31286087 PMCID: PMC6588836 DOI: 10.1016/j.case.2019.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Migrated endovascular stent used for dialysis found in the right atrium. Chronic embedded stent in the right atrium. Echocardiographic evidence of embedded stent in the right atrium.
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Affiliation(s)
- Jonathon M Blais
- Department of Internal Medicine, Genesys Regional Medical Center, Grand Blanc, Michigan
| | - Marcel Letourneau
- Department of Cardiovascular Medicine, Genesys Regional Medical Center, Grand Blanc, Michigan
| | - Andrew Hinojos
- Department of Cardiovascular Medicine, Genesys Regional Medical Center, Grand Blanc, Michigan
| | - Reginald Sandy
- Department of Internal Medicine, Genesys Regional Medical Center, Grand Blanc, Michigan
| | - Tiana Gray
- Department of Cardiovascular Medicine, Genesys Regional Medical Center, Grand Blanc, Michigan
| | - Thomas Miller
- Department of Cardiovascular Medicine, Genesys Regional Medical Center, Grand Blanc, Michigan
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16
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Zvavanjanja RC. Percutaneous retrieval of migrated Viabahn stent from a segmental pulmonary artery. CVIR Endovasc 2019; 1:1. [PMID: 30652134 PMCID: PMC6319534 DOI: 10.1186/s42155-018-0007-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 04/05/2018] [Indexed: 12/25/2022] Open
Abstract
Background With improving and aggressive endovascular venous and dialysis techniques there is increasing use of stent grafts with different platforms available on the market. Inappropriately sized stents may displace and potentially end up in the heart or lungs as potential dangerous foreign bodies. There is single published case of successful viabahn stent graft retrieval from the pulmonary circulation. Case presentation We present a patient who had successful safe percutaneous retrieval of a migrated Viabahn stent from a segmental Pulmonary artery and describe a different novel safe technique of successful stent graft retrieval from the pulmonary artery with very low risk to potential damage to the cardiac valve complex. Conclusion This case report demonstrates that Viabahn stent grafts can be safely retrieved from the pulmonary arterial system using this endovascular technique that will significantly reduce the risk of damage to the cardiac valve complex therefore avoiding potential complex surgery. Electronic supplementary material The online version of this article (10.1186/s42155-018-0007-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- R C Zvavanjanja
- Department of Diagnostic and Interventional Imaging, University of Texas Health Science Center at Houston, McGovern Medical School, 6431 Fannin St, MSB 2.132, Houston, TX 77030 USA
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17
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Yamaguchi T, Miyamoto T, Kawahatsu K, Nozato T. Very early great saphenous vein graft aneurysm treated by percutaneous coronary intervention under ChromaFlo imaging guidance. BMJ Case Rep 2017; 2017:bcr-2017-220443. [PMID: 28729378 DOI: 10.1136/bcr-2017-220443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 73-year-old man, who had undergone coronary artery bypass grafting (CABG) 10 days prior, presented with a great saphenous vein graft aneurysm (SVGA). CT revealed the increasing size of the aneurysm. Since the SVGA occurred immediately after CABG and there were no other complications, the aneurysm was treated percutaneously. While intravascular ultrasonography (IVUS) and optical coherence tomography failed to detect the entry point, an IVUS catheter with the addition of ChromaFlo imaging clearly revealed the entry point, size and length of the SVGA. To prevent migration and edge restenosis associated with covered stents, the covered stent (3.0×19 mm) was superimposed on a drug-eluting stent (3.0×28 mm) that covered the entry site. A follow-up study demonstrated the absence of flow into the aneurysm.
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Affiliation(s)
- Tetsuo Yamaguchi
- Department of Cardiology, Japanese Red Cross Musashino Hospital, Tokyo, Japan
| | - Takamichi Miyamoto
- Department of Cardiology, Japanese Red Cross Musashino Hospital, Tokyo, Japan
| | - Kandoh Kawahatsu
- Department of Cardiology, Japanese Red Cross Musashino Hospital, Tokyo, Japan
| | - Toshihiro Nozato
- Department of Cardiology, Japanese Red Cross Musashino Hospital, Tokyo, Japan
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18
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Intracardiac Venous Stent Migration: Emergency Department Presentation of a Catastrophic Complication. J Emerg Med 2017; 53:e11-e13. [DOI: 10.1016/j.jemermed.2017.01.053] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Revised: 01/20/2017] [Accepted: 01/23/2017] [Indexed: 11/22/2022]
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19
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Hesterberg K, Babu A, Frank M, Hogan S, Krantz MJ. Severe tricuspid regurgitation due to valvular entrapment of an inferior vena cava stent. Clin Case Rep 2017; 5:130-133. [PMID: 28174637 PMCID: PMC5290522 DOI: 10.1002/ccr3.812] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Revised: 09/18/2016] [Accepted: 12/06/2016] [Indexed: 12/03/2022] Open
Abstract
Endovascular venous stenting is increasingly performed for a variety of conditions. Inferior vena cava stent migration has been reported up to 6 months after placement; stent migration 6 months after implantation is uncommon. To our knowledge, this is only the second reported case of late stent migration with valve entrapment 1.
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Affiliation(s)
| | - Ashok Babu
- University of Colorado, Cardiothoracic Surgery Aurora, Colorado USA
| | - Maria Frank
- Denver Health Medical Center Denver Colorado USA
| | - Shea Hogan
- Denver Health Medical Center Denver Colorado USA
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20
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Vu J, Kim SK. Percutaneous retrieval of a misplaced transjugular intrahepatic portosystemic shunt stent using the rigid endobronchial forceps. INTERNATIONAL JOURNAL OF GASTROINTESTINAL INTERVENTION 2016. [DOI: 10.18528/gii160001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- John Vu
- Interventional Radiology, Mallinckrodt Institute of Radiology, Washington University St. Louis School of Medicine, St. Louis, MO, USA
| | - Seung Kwon Kim
- Interventional Radiology, Mallinckrodt Institute of Radiology, Washington University St. Louis School of Medicine, St. Louis, MO, USA
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21
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Abstract
Stent migration is an inherent complication of stent deployment. A number of factors are responsible for this dreaded complication. The stent may eventually migrate to the heart or lungs or in the process of migration damage structures en route to its final destination. A number of techniques are available to bail out interventionalists if such a situation should arise. Occasionally a wait and watch approach may be prudent.
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Dinkel HP, Mettke B, Schmid F, Baumgartner I, Triller J, Do DD. Endovascular Treatment of Malignant Superior Vena Cava Syndrome: Is Bilateral Wallstent Placement Superior to Unilateral Placement? J Endovasc Ther 2016; 10:788-97. [PMID: 14533962 DOI: 10.1177/152660280301000416] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose: To report our experience with unilateral versus bilateral stent placement in the treatment of malignant superior vena cava syndrome (SVCS). Methods: The records and films of 84 consecutive patients (69 men; mean age 64±10 years, range 39–79) referred for stent placement in malignant SVCS were reviewed for venous compromise, technical and clinical success, complications, and reocclusions. Wallstents were placed covering the SVC and both (bilateral technique) brachiocephalic veins (BCV) preferentially; unilateral stenting of only one BCV in addition to the SVC was performed based on operator preference or inability to access both sides. Technical success was defined as the ability to stent the SVC and at least one BCV; clinical success was the elimination of SVCS symptoms. Results: Technical success was achieved in 83 (99%) patients, using the unilateral technique in 22 and bilateral stenting in 61 patients. The groups did not differ with regard to age, sex, underlying diseases, or location and extent of venous compromise. Immediate clinical success was achieved in 20 (91%) of 22 patients in the unilateral group and 55 (90%) of 61 patients in the bilateral group. Two patients suffered late occlusion in the unilateral group, while in the bilateral group, 8 patients had early occlusion and 9 had late occlusion. Thus, the total occlusion rate was significantly (p<0.05) lower in the unilateral group. There was 1 other complication (pericardial tamponade) in the bilateral group, for a 28% total complication rate, which was significantly higher (p = 0.039) than the 9% in the unilateral group. The 1, 3, 6, and 12-month primary stent patency rates were 90%, 81%, 76%, and 69%, respectively. Patency tended to last longer in the unilateral group, but the difference was not significant (p = 0.11). Conclusions: Although bilateral Wallstent placement achieved equal technical and clinical success, it tended to confer shorter-lived patency and caused more complications.
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Affiliation(s)
- Hans-Peter Dinkel
- Department of Diagnostic Radiology, Inselspital, University Hospital of Berne, Switzerland.
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23
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Kobayashi D, Gowda ST, Forbes TJ. A novel balloon assisted two-stents telescoping technique for repositioning an embolized stent in the pulmonary conduit. Catheter Cardiovasc Interv 2014; 84:219-23. [PMID: 24402732 DOI: 10.1002/ccd.25383] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Revised: 12/18/2013] [Accepted: 01/03/2014] [Indexed: 11/09/2022]
Abstract
A 9-year-old male, with history of pulmonary atresia and ventricular septal defect, status post complete repair with a 16 mm pulmonary homograft in the right ventricular outflow tract (RVOT) underwent 3110 Palmaz stent placement for conduit stenosis. Following deployment the stent embolized proximally into the right ventricle (RV). We undertook the choice of repositioning the embolized stent into the conduit with a transcatheter approach. Using a second venous access, the embolized stent was carefully maneuvered into the proximal part of conduit with an inflated Tyshak balloon catheter. A second Palmaz 4010 stent was deployed in the distal conduit telescoping through the embolized stent. The Tyshak balloon catheter was kept inflated in the RV to stabilize the embolized stent in the proximal conduit until it was successfully latched up against the conduit with the deployment of the overlapping second stent. One year later, he underwent Melody valve implantation in the pre-stented conduit relieving conduit insufficiency. This novel balloon assisted two-stents telescoping technique is a feasible transcatheter option to secure an embolized stent from the RV to the RVOT.
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Affiliation(s)
- Daisuke Kobayashi
- Division of Pediatric Cardiology, Children's Hospital of Michigan, Carman and Ann Adams Department of Pediatrics, Wayne State University School of Medicine, Detroit, Michigan
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24
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Abstract
For more than 10 years, balloon-expandable intravascular stents have become an integral part of treatment for obstructive vascular lesions in children and adults with congenital heart disease. The initial problems with stents, such as sharp edges, rigid frame and unacceptable shortening when over-expanded have been overcome to a large extent with the newer designs. The problems related to delivery of stents, such as stent migration, balloon rupture, flaring of the edges of the stent, rupture of vessels and milking of the stent off the balloon, have also been overcome by newer designs of balloons. The failure of growth of balloon-expandable stents with the growth of the child is managed by redilation with or without additional stenting and newer growth stents. Self-expanding stents are not appropriate for use in growing children due to the limitation of their maximum diameters. The development of biodegradable stents may overcome these disadvantages in the future. Various new developments have recently occurred. Covered stents are ideal for treating acute vessel rupture and in isolating vascular aneurysms. Drug-eluting stents may prevent restenosis, but have not been used in children. Valved stents are a recent innovation for the treatment of regurgitant pulmonary valves.
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Affiliation(s)
- Shakeel Ahmed Qureshi
- Department of Pediatric Cardiology, Guy's Hospital, 11th Floor Guy's Tower, St Thomas Street, London SE1 9RT, UK.
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25
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Papakostas JC, Theodoropoulos E, Karydas G, Chatzigakis PK. Contained rupture of a celiac artery aneurysm treated with aortic endograft deployment and assisting percutaneous coil and thrombin infusion. Vascular 2013; 21:183-8. [DOI: 10.1177/1708538113478735] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
In this report we present a case of a ruptured celiac artery aneurysm (CAA) with a thrombosed distal neck, which was treated as an emergently with a deployment of a tube thoracic endograft to the descending thoracic and upper abdominal aorta. The initial treatment was assisted with a second stage percutaneous, transhepatic, ultrasound guided needle infusion of coil and thrombin to the aneurysmal sac due to type Ib endoleak, with immediate thrombosis of the aneurysm. This technique, although not standard, could also be considered as a useful choice for the treatment of CAAs with wide proximal and patent distal neck.
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Affiliation(s)
| | - Emmanouil Theodoropoulos
- Department of Interventional Radiology, ‘G. Gennimatas’ General Hospital of Athens, Athens, Greece
| | - George Karydas
- Department of Interventional Radiology, ‘G. Gennimatas’ General Hospital of Athens, Athens, Greece
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26
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Rana MA, Oderich GS, Bjarnason H. Endovenous removal of dislodged left renal vein stent in a patient with nutcracker syndrome. Semin Vasc Surg 2013; 26:43-7. [DOI: 10.1053/j.semvascsurg.2013.04.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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27
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Canavati R, How TV, Brennan JA, Vallabhaneni SR, Fisher RK, McWilliams RG. Fractured superior mesenteric artery stents after fenestrated endovascular aneurysm repair. J Vasc Surg 2013; 57:511-4. [DOI: 10.1016/j.jvs.2012.08.043] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2012] [Revised: 08/06/2012] [Accepted: 08/08/2012] [Indexed: 11/27/2022]
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28
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Wendler C, Shoenberger JM, Mailhot T, Perera P. Transjugular Intrahepatic Portosystemic Shunt (TIPS) Migration to the Heart Diagnosed by Emergency Department Ultrasound. THE WESTERN JOURNAL OF EMERGENCY MEDICINE 2013; 13:525-6. [PMID: 23358693 PMCID: PMC3555599 DOI: 10.581/westjem.2012.5.12592] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/03/2012] [Revised: 05/10/2012] [Accepted: 05/14/2012] [Indexed: 11/25/2022]
Abstract
A 57-year-old man presented to our emergency department with altered mental status. He had a past medical history significant for cirrhosis and previous placement of a transjugular intrahepatic portosystemic shunt (TIPS). On cardiac auscultation, a new heart murmur and an unexpected degree of cardiac ectopy were noted. On the 12-lead electrocardiogram, the patient was noted to have multiple premature atrial contractions, corroborating the irregular heart rhythm on physical exam. A focused bedside emergency ultrasound of the heart was then performed. This exam revealed an apparent foreign body in the right atrium. It appeared as if the patient’s TIPS had migrated from the heart into the right atrium. This case, as well as the literature describing this unusual complication of TIPS placement, is reviewed in this case report.
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Affiliation(s)
- Carlan Wendler
- Los Angeles County + University of Southern California, Department of Emergency Medicine, Los Angeles, California
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29
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Ray MJ, Savage C, Klintmalm GB, Rees CR. Endovascular caudal retraction of the cranial end of a misplaced Viatorr TIPS prior to liver transplantation. Proc AMIA Symp 2012; 25:341-3. [PMID: 23077382 DOI: 10.1080/08998280.2012.11928871] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Transjugular intrahepatic portosystemic shunt (TIPS) extension far into the inferior vena cava (IVC) or the right atrium may complicate or preclude orthotopic liver transplantation depending on the space available for placement of a hemostatic clamp in the suprahepatic IVC. Until 2004, most TIPS were performed with bare metal stents, which integrate into the vessel wall, making percutaneous or intraoperative repositioning uncertain. Most TIPS are currently created with stent grafts that have an outer fabric to increase shunt patency and prevent endothelial ingrowth. We describe the first known manipulation of a covered stent graft prior to transplantation. The stent graft, which extended well into the IVC, was snared from a femoral approach and deflected caudally in order to document feasibility and nonadherence to the vein wall prior to definitive surgical planning of liver transplantation. Provisions were made for endovascular retraction during actual transplant surgery 9 weeks later, but this became unnecessary when manual retraction of the exposed liver enabled suprahepatic IVC clamping. Due to the nonadherent nature of the outer graft material, compared with a bare metal stent, extension of a stent graft into the IVC or right atrium may not preclude transplantation, and intraoperative endovascular retraction may be considered.
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Affiliation(s)
- M Jordan Ray
- Department of Radiology (Ray, Rees) and the Department of Transplant Surgery (Klintmalm), Baylor University Medical Center at Dallas; and the Department of Radiology, The University of Texas Southwestern Medical Center at Dallas (Savage)
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30
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Sugahara T, Nakashima K, Suzuki R, Hagio K, Azuma M, Ito K, Baba Y, Uetani H. Percutaneous removal of a fully expanded SMART stent from the pulmonary artery using various adjunctive techniques. Jpn J Radiol 2012; 30:688-92. [PMID: 22875584 DOI: 10.1007/s11604-012-0109-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2012] [Accepted: 07/11/2012] [Indexed: 11/30/2022]
Abstract
A 36-year-old man with an implanted arteriovenous shunt for hemodialysis was referred for shunt malfunction. Venography of the right upper extremity showed occlusion of the subclavian vein, and a SMART stent was deployed. The fully expanded stent immediately migrated centrally into the left pulmonary artery. As initial efforts to pass a snare over the stent failed, we intentionally passed a microguidewire through stent interstices, snared the end of the microguidewire to create a loop, and pulled the stent/microguidewire/snare combination back into the right ventricle where it separated from the loop because of stent mesh destruction. As the stent remained in the right ventricle, we advanced a 0.035-in. guidewire into the stent lumen, passed an angioplasty balloon over the guidewire, inflated the balloon in the stent, and performed pull-back into the right distal external iliac artery. The stent was then surgically removed via a right inguinal incision without eliciting any complications. Although retrieval of the stent malpositioned in the pulmonary artery was difficult, we retrieved it safely by applying various adjunctive techniques.
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Affiliation(s)
- Takeshi Sugahara
- Department of Radiology, Japanese Red Cross Kumamoto Hospital, 2-1-1 Nagamine-minami, Higashi-ku, Kumamoto 861-8520, Japan.
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31
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Vascular Stent Fracture and Migration to Pulmonary Artery during Arteriovenous Shunt Thrombectomy. J Vasc Access 2012; 14:175-9. [DOI: 10.5301/jva.5000105] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/29/2012] [Indexed: 11/20/2022] Open
Abstract
Purpose Endovascular stent fracture and migration is an extremely rare complication of arteriovenous shunt thrombectomy. Technique We report a case of endovascular stent fracture following repeat arteriovenous graft thrombectomy, which was complicated by migration of a 26 millimeter stent fragment to the left main pulmonary artery. Attempts at percutaneous transvenous retrieval were unsuccessful, and an open thoracotomy to extract the stent fragment was performed. Conclusions Although there is no consensus for the management of endovascular stents that have migrated to the pulmonary arteries, stent retrieval may be necessary in cases where arterial flow is compromised or heavy clot burden is a concern. Moreover, steps toward prevention of stent fracture and migration should be considered in order to preclude such occurrences – avoidance of puncturing the stent for hemodialysis access, discontinuation of use of the Arrow-Trerotola device through or near stents, and consideration of short segment angioplasty for regional intrastent stenosis rather than typical long segment venous angioplasty.
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32
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Bani-Hani S, Showkat A, Wall BM, Das P, Huang L, Al-Absi AI. Endovascular stent migration to the right ventricle causing myocardial injury. Semin Dial 2012; 25:562-4. [PMID: 22348654 DOI: 10.1111/j.1525-139x.2011.01039.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Central stenosis of the subclavian and internal jugular veins is common in end stage renal disease. Treatment of these stenoses is difficult as these veins respond poorly to angioplasty alone and often require metallic stents to ensure patency. These stents are not without complications. Reports of stent fracture, thrombosis and vessel rupture abound in the literature. Stent migration can occur when used in large central veins leading to severe consequences such as pulmonary infarction, tricuspid regurgitation and right sided heart failure. In this report, we report a case of a subclavian vein stent which migrated into the right heart and caused subendocardial injury. As the use of vascular stents is becoming a common treatment option for central venous stenosis, the occurrences of serious complications associated with the stents are likely to rise.
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Affiliation(s)
- Samer Bani-Hani
- Nephrology Division, University of Tennessee Health Sciences Center (UTHSC), Memphis, TN 38016, USA
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33
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Ahn JH, Kim JY, Jeon YS, Cho SG, Park JK, Lee KJ, Hong KC. Successful treatment of type I endoleak of common iliac artery with balloon expandable stent (Palmaz XL stent) during endovascular aneurysm repair. JOURNAL OF THE KOREAN SURGICAL SOCIETY 2012; 82:59-62. [PMID: 22324049 PMCID: PMC3268146 DOI: 10.4174/jkss.2012.82.1.59] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/14/2011] [Revised: 07/29/2011] [Accepted: 08/29/2011] [Indexed: 11/30/2022]
Abstract
Type 1 endoleak of common iliac artery (type Ib endoleak) should be treated during endovascular aneurysm repair (EVAR). An 86-year-old female was diagnosed with abdominal aortic aneurysm measuring 6.6 cm in diameter and right internal iliac artery aneurysm measuring 4.0 cm in diameter. She underwent EVAR after right internal iliac artery embolization. There was type Ib endoleak, which was repaired by balloon-expandable stent, Palmaz XL stent (Cordis). We report successful treatment of type Ib endoleak with Palmaz XL stent, which may be considered as an alternative option for type Ib endoleak after EVAR.
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Affiliation(s)
- Jong Hyuk Ahn
- Department of Surgery, Inha University School of Medicine, Incheon, Korea
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34
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Tivener D, Vannucci A, Fagley RE, Doyle M, Shenoy S, Chapman W, Kangrga I. Atrial laceration caused by removal of a transjugular intrahepatic portosystemic shunt necessitates emergent cardiopulmonary bypass during liver transplant: a case report. Transplant Proc 2012; 43:2810-3. [PMID: 21911169 DOI: 10.1016/j.transproceed.2011.03.093] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2011] [Accepted: 03/30/2011] [Indexed: 01/14/2023]
Abstract
In situ transjugular intrahepatic portosystemic shunting (TIPS) can complicate liver transplantation. We present a case where an intraoperative attempt to remove a malpositioned TIPS resulted in atrial laceration. Massive transfusion and emergent institution of cardiopulmonary bypass allowed patient resuscitation and completion of surgery. We describe our surgical and anesthesiologic management, and discuss the absence of criteria to predict when TIPS may become adherent to the inferior vena cava or the right atrium and difficult to remove.
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Affiliation(s)
- D Tivener
- Department of Anesthesiology, Washington University in St. Louis - School of Medicine, St. Louis, MO 63110, USA
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35
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Kang W, Kim IS, Kim JU, Cheon JH, Kim SK, Ko SH, Kim SH, Lee SW, Cho SH. Surgical removal of endovascular stent after migration to the right ventricle following right subclavian vein deployment for treatment of central venous stenosis. J Cardiovasc Ultrasound 2011; 19:203-6. [PMID: 22259665 PMCID: PMC3259546 DOI: 10.4250/jcu.2011.19.4.203] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2011] [Revised: 09/27/2011] [Accepted: 11/30/2011] [Indexed: 11/22/2022] Open
Abstract
Central venous stenosis or occlusion occurs in 11-50% of hemodialysis patients with prior subclavian vein cannulation and ipsilateral fistula or shunt. Most patients are asymptomatic but some require treatment to reduce the risk of thrombosis and improve inadequate hemodialysis pressure. In these cases, endovascular intervention, including ballooning and stenting, is a feasible strategy for selected patents. We report an unusual case of a 40-year-old man on hemodialysis that underwent endovascular stenting to treat right subclavian vein stenosis and experienced stent migration to the right ventricle, requiring surgical removal.
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Affiliation(s)
- Wook Kang
- Department of Internal Medicine, Busan Veterans Hospital, Busan, Korea
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36
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Siani A, Accrocca F, Gabrielli R, Marcucci G. Acute lower limb ischaemia due to delayed upstream migration of an iliac stent. Interact Cardiovasc Thorac Surg 2011; 14:231-3. [PMID: 22159244 DOI: 10.1093/icvts/ivr045] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
We report a case of acute limb ischaemia due to unusual upstream stent migration into the aorta 2 years after successful kissing stenting. Angiography showed a misplacement of both common iliac stent into the aorta, upstream migration with a fracture on the left external iliac stent into the iliac common artery, occlusion of the left iliac and femoral artery, dilatation of aortic bifurcation and stent separation on the right side. The patient underwent a successful axillo-bifemoral bypass graft. Vessel wall remodelling due to overestimation of stent size, aortic turbulence and rebound effect may explain this complication.
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Affiliation(s)
- Andrea Siani
- Unit of Vascular and Endovascular Surgery, San Paolo Hospital, Rome, Italy
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37
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Yoo YS, Park HS, Lee T. Successful Repositioning of an Inadvertently Deployed Unexpanded Stent. Vasc Specialist Int 2011. [DOI: 10.5758/kjves.2011.27.4.180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Young Sun Yoo
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
- Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hyung Sub Park
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
- Seoul National University Bundang Hospital, Seongnam, Korea
| | - Taeseung Lee
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
- Seoul National University Bundang Hospital, Seongnam, Korea
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38
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Negri S, Ferraro S, Piffaretti G, Rivolta N, Bossi M, Carrafiello G, Castelli P. An unusual case of stent migration after celiac trunk endovascular revascularization. Cardiovasc Intervent Radiol 2011; 35:950-3. [PMID: 22113207 DOI: 10.1007/s00270-011-0303-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2011] [Accepted: 10/16/2011] [Indexed: 12/13/2022]
Abstract
A 61-year-old woman underwent celiac trunk stenting to treat abdominal angina. Three months later, she was readmitted for recurrent symptoms. Computed tomography control revealed the migration of the stent into the splenic artery. No sign of vessel injury or end-organ ischemia was detected. Repeat stenting of the celiac trunk was performed; the postoperative course was uneventful. 12 months later, the patient was asymptomatic with the second stent in its correct position, and she was asymptomatic for mesenteric ischemia.
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Affiliation(s)
- Silvia Negri
- Vascular Surgery, Department of Surgical Sciences, Circolo University Hospital, University of Insubria School of Medicine, Varese, Italy
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39
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Ahamed SH, Venkatesh SK, Tan LKA. Migrated Brachiocephalic Venous Stent into the Right Atrium – Can it be Left Alone? A Case Report and Review of the Literature. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2011. [DOI: 10.47102/annals-acadmedsg.v40n11p512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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40
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Affiliation(s)
- Brian Funaki
- Associate Professor and Section Chief, Section of Vascular and Interventional Radiology, and Section of Abdominal Imaging, University of Chicago Hospitals, Chicago, Illinois
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41
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Ripamonti R, Ferral H, Alonzo M, Patel NH. Transjugular intrahepatic portosystemic shunt-related complications and practical solutions. Semin Intervent Radiol 2011; 23:165-76. [PMID: 21326760 DOI: 10.1055/s-2006-941447] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Despite the clinical complexity of patients with severe liver disease and the technical demands associated with the creation of a transjugular intrahepatic portosystemic shunt (TIPS), the major complication rate of this procedure is less than 5%. Delayed recognition and treatment of complications related to TIPS can have life-threatening consequences. This article provides an overview of the spectrum of periprocedural and delayed complications related to the performance of TIPS and offers the reader pearls for both avoiding and managing those complications.
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Affiliation(s)
- Renato Ripamonti
- Department of Diagnostic Radiology, Section of Interventional Radiology, Rush University Medical Center, Chicago Illinois
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Comprehensive review of TIPS technical complications and how to avoid them. AJR Am J Roentgenol 2011; 196:675-85. [PMID: 21343513 DOI: 10.2214/ajr.10.4819] [Citation(s) in RCA: 84] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE The goal of this article is to describe potential technical complications related to transjugular intrahepatic portosystemic shunts (TIPS) placement and to discuss strategies to avoid and manage complications if they arise. CONCLUSION TIPS is an established interventional therapy for complications of portal hypertension. Although TIPS remains a relatively safe procedure, direct procedure-related morbidity rates are as high as 20%. The technical complexity of this intervention increases the risk for methodologic mishaps during all phases of TIPS placement, including venous access and imaging, transhepatic needle puncture, shunt insertion, and variceal embolization. Thus, interventional radiologists require a thorough stepwise understanding of TIPS insertion, possible adverse sequela, and technical tips and tricks to maximize the safety of this procedure.
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Dashkoff N, Blessios GA, Cox MR. Migration of covered stents from hemodialysis A-V access to the pulmonary artery: Percutaneous stent retrieval and procedural trends. Catheter Cardiovasc Interv 2010; 76:595-601. [DOI: 10.1002/ccd.22553] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Alomari AI. Percutaneous Retrieval of an Intravascular Fluency Stent-Graft Using a Rigid Alligator Forceps: Case Report. Semin Dial 2010; 23:220-3. [DOI: 10.1111/j.1525-139x.2010.00710.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Superior Vena Cava Stent Migration into the Pulmonary Artery Causing Fatal Pulmonary Infarction. Cardiovasc Intervent Radiol 2010; 34 Suppl 2:S198-201. [DOI: 10.1007/s00270-010-9812-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2009] [Accepted: 01/04/2010] [Indexed: 10/19/2022]
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Mughal MM, Broughton WA, Awan GM. Stuck in the wrong place. Am J Med 2009; 122:e7-8. [PMID: 19854316 DOI: 10.1016/j.amjmed.2009.02.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2008] [Revised: 02/18/2009] [Accepted: 02/28/2009] [Indexed: 12/01/2022]
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Byrne RA, Mylotte D, Nolan P, Nash P. Migration of inferior vena cava stent into right ventricle: two- and three-dimensional echocardiographic imaging. Eur Heart J Cardiovasc Imaging 2008; 10:370-1. [PMID: 19091792 DOI: 10.1093/ejechocard/jen325] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Right ventricular migration of a systemic venous stent is a rare complication. We present a case of stent migration in a 65-year-old male who underwent palliative intervention for inferior vena cava compression secondary to malignant mesothelioma. Two- and three-dimensional echocardiographic images revealed evidence of a free-stent trapped in the tricuspid valvular apparatus causing severe tricuspid regurgitation.
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Affiliation(s)
- Robert A Byrne
- Department of Cardiology, University College Hospital, Galway, Ireland.
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Kim JK, Noll RE, Tonnessen BH, Sternbergh WC. A technique for increased accuracy in the placement of the “giant” Palmaz stent for treatment of type IA endoleak after endovascular abdominal aneurysm repair. J Vasc Surg 2008; 48:755-7. [DOI: 10.1016/j.jvs.2008.05.023] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2008] [Revised: 05/06/2008] [Accepted: 05/06/2008] [Indexed: 11/29/2022]
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Warren MJ, Sen S, Marcus N. Management of Migration of a SVC Wallstent into the Right Atrium. Cardiovasc Intervent Radiol 2008; 31:1262-4. [DOI: 10.1007/s00270-008-9389-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2007] [Revised: 05/15/2008] [Accepted: 06/16/2008] [Indexed: 11/28/2022]
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Schefold JC, Krackhardt F. Dislocation of a metal stent to the right ventricle: an unusual finding in the heart. J Cardiovasc Med (Hagerstown) 2008; 9:742-3. [DOI: 10.2459/jcm.0b013e3282f3f675] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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