Iliac Vein Stent Migration to the Right Ventricle
A 37-year-old obese male-to-female transgender patient with past medical history of venous insufficiency presented to the hospital with chest pain. The patient was in her usual state of health until 2 days prior to admission when she developed right-sided sudden onset chest pain radiating to the back and neck while walking up the stairs. Chest pain has been intermittent and positional and was brought on by upper body motion. Upon further questioning, the patient reported undergoing an elective left common iliac vein stent placement the day prior to her symptoms started for management of venous insufficiency. Upon arrival to the hospital, the patient was hemodynamically stable. A transthoracic echocardiogram was performed that revealed a hyperechoic linear tubular structure seen in the right atrium measuring approximately 6 cm in length and crossing the tricuspid leaflet with impingement into the right ventricular septum (Figures 1-2). The findings were consistent with migration of the recently placed iliac vein stent.
Two approaches for stent removal were considered: endovascular versus surgical retrieval. Given the location of the stent entangled in the tricuspid valve, endovascular retrieval was deemed higher risk for structural damage by the interventionalists. Subsequently, a successful complex surgical repair was performed, which included retrieval of the nitinol stent visualized protruding through the right atrial free wall. Furthermore, drainage of hemorrhagic pericardial effusion, atrial free wall repair, and tricuspid valve repair were performed (Figure 3). Postoperative course was uneventful. Follow-up evaluation in the clinic was also unremarkable.
Based on the 2014 CIRSE Standards of Practice Guidelines on Iliocaval Stenting, which of the following is a recommendation to consider iliocaval stent placement?