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An Unusual Case of Stent Migration From the Right Thigh Arteriovenous Graft to the Right Heart and Left Pulmonary Artery FREE TO VIEW

Naveen Rawat*, MBBS; Nivas Balasubramaniyam, MBBS; Stuart Lehrman, MD; Wilbert Aronow, MD
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Westchester Medical Center, Valhalla, NY

Chest. 2012;142(4_MeetingAbstracts):966A. doi:10.1378/chest.1371315
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SESSION TYPE: Miscellaneous Case Report Posters I

PRESENTED ON: Tuesday, October 23, 2012 at 01:30 PM - 02:30 PM

INTRODUCTION: We report a unusual case of migration of the right femoral AV graft stent migration to right ventricle and left pulmonary artery.

CASE PRESENTATION: We had 44 year old female who was transferred from an outside facility where she was admitted for acute left inguinal, suprapubic and back pain for 2 days prior to her presentation. Patient had a past medical history of lupus nephritis which progressed to End Stage Renal Disease for which she had a right thigh AV graft placed 7 years ago between the superficial femoral artery and the superficial femoral vein. She had several graft interventions done in the subsequent year and one among those is notable for the placement of two 7*37 and 7*27 stents that were placed on the venous side 5 years before presentation.The computerized tomography scan of the chest, abdomen and pelvis done as a part of workup revealed the presence of large left renal and retroperitoneal hematoma. Incidentally stent material was found in the left lower lobar pulmonary artery and in the right atrium extending to the right ventricle. The position of the stent was confirmed with a transesophageal echocardiogram .Cardiothoracic surgeon advised to manage the stents conservatively as the risks of tricuspid valve and chordae tendineae damage outweighed the benefit of surgery. She was discharged in stable condition.

DISCUSSION: There have been several reports of migration of stents to the right heart and the pulmonary artery from the inferior and superior vena cavae. Migration of stent from the AV graft is rarely reported. One case reported describes the embolization of stent placed in the right arm AV graft to the right heart causing tricuspid regurgitation requiring surgical intervention. In our case we report an unusual migration of stent placed in the right thigh AV graft which migrated and lodged in the right side of the heart and the right pulmonary artery. Although there were no complications in our case, there have been reports of several complications arising from the embolized stent requiring surgical intervention.

CONCLUSIONS: It is important for the medical community to be aware of the possibility of stent embolization and migration which could result in complications.

1) Embolization of a stent from an arteriovenous graft into the right ventricle in a patient on chronic hemodialysis.Poorya Fazel, MD, Jeffrey M. Schussler, MD, Rafic F. Berbarie, MD, Baron L. Hamman, MD, and Andrew Z. Fenves, MD.Proc (Bayl Univ Med Cent). 2011 April; 24(2): 94-95.

2) Migration of intravascular metallic stent into pulmonary artery.Ajay K. Sharma, Sanjay Sinha and Ali Bakran Nephrol. Dial. Transplant. (2002) 17 (3): 511.

3) Severe Tricuspid Regurgitation Secondary to Subclavian Vein Stent Migration , 03 December 2007 .K. Rehman, T. Ojimba, T. Gardecki .European Journal of Vascular & Endovascular Surgery February 2008 (Vol. 35, Issue 2, Page 249)

DISCLOSURE: The following authors have nothing to disclose: Naveen Rawat, Nivas Balasubramaniyam, Stuart Lehrman, Wilbert Aronow

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Westchester Medical Center, Valhalla, NY




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