SESSION TITLE: Pulmonary Vascular Diseases Student/Resident Cases
SESSION TYPE: Student/Resident Case Report Slide
PRESENTED ON: Tuesday, October 27, 2015 at 04:30 PM - 05:30 PM
INTRODUCTION: Coil embolization is a therapy with excellent outcomes and low complication rates for symptomatic patients with persistent or recurrent varicoceles. Rarely, however, coils may migrate to the pulmonary vasculature. We present a patient with a pulmonary infarction after coil migration to the left pulmonary artery.
CASE PRESENTATION: A 51 year-old male underwent coil embolization of the bilateral gonadal veins for chronic testicular pain. The procedure was complicated by migration of a 6x7mm coil into a subsegmental branch of the left pulmonary artery (figure 1A and 1B). The patient was asymptomatic and clinically stable. Attempts to retrieve the coil by endovascular snare were unsuccessful. Two months later, computed tomography demonstrated a small 4mm pulmonary infarct distal to the coil (figure 1C). The patient remained asymptomatic and the risk of surgical retrieval was determined to outweigh the potential benefits.
DISCUSSION: Foreign body migration to the pulmonary vessels may complicate a variety of endovascular procedures. Most cases involve intravascular catheter fragments while other embolized foreign bodies include IVC filters, guidewires, stents, and bone cement. Iatrogenic devices can migrate to the pulmonary circulation from as far away as the pelvic and intracerebral venous systems. A review of 135 publications describing 574 cases of intravascular foreign body embolization found only 16 cases of embolization coil migration. Potential complications include secondary clot formation, secondary infection, pulmonary infarction, bronchus erosion, and even death. However, less than 6% of patients are symptomatic. The vast majority of iatrogenic foreign bodies can be retrieved by endovascular snare or other devices, though a minority will warrant surgical resection. Time to retrieval as long as 11 years after the initial event has been described.
CONCLUSIONS: Foreign body migration to the pulmonary vasculature is a rare complication of coil embolization of varicoceles. Most patients are asymptomatic and the decision to retrieve the device should be made on an individual basis.
Reference #1: Schechter MA, O’Brien PJ, and Cox MW. Retrieval of iatrogenic intravascular foreign bodies. J Vasc Surg 2013;57:276-81.
Reference #2: Yamasaki W, Kakizawa H, et al. Migration to the pulmonary artery of nine metallic coils placed in the internal iliac vein for treatment of giant rectal varices. Acta Radiologica Short Reports 2012;1:22.
Reference #3: Thanigaraj S, Panneerselvam A, and Yanos J. Retrieval of an IV catheter fragment from the pulmonary artery 11 years after embolization. Chest 2000; 117:1209-1211.
DISCLOSURE: The following authors have nothing to disclose: Jennifer Fu, David Hsia
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