Migration of intra-vascular metallic stent into pulmonary artery

(Section Editor: G. H. Neild)

Ajay K. Sharma, Sanjay Sinha and Ali Bakran

The Transplant Unit, Royal Liverpool University Hospital, Liverpool, UK

Keywords: embolism; stent migration

Case

Successful snare retrieval of embolized fragments of central venous catheters in the right heart and pulmonary circulation has been reported [1].

A 70-year-old gentleman with end-stage renal failure on maintenance haemodialysis developed stenosis of the right subclavian vein at the junction of its middle and medial one third following a previous insertion of dialysis catheter through the vein. The stenosis was subjected to percutaneous venous dilatation with placement of an intra-vascular expanding metallic stent (Wallstent 12 mm). There was immediate improvement in his venous oedema. Four months later the chest X-ray showed that the stent had migrated to the right pulmonary artery. Since he remained asymptomatic, a non-intervention policy was utilized. However, he required another intra-vascular stent placement because of recurrence of venous hypertension in that arm 5 months later. He received a cadaveric renal transplantation 2 years later (Figure 1)Go.



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Fig. 1.  Intravascular metallic wire stent migrated into right pulmonary artery.

 
The migrated stent did not have any subsequent clinical sequelae. In particular, there was no pulmonary infarcation or sepsis secondary to the stent migration. Seven years later both stents remained in situ at the time of patient's death, which was due to septicaemia following a urinary tract infection. The migration of an intra-vascular stent is a rarely reported complication. It has been managed successfully by ‘watch-and-wait’ policy because of the large size of stent [2]. Our case highlights the appropriateness of this approach.

Notes

Correspondence and offprint requests to: A. Bakran, Link 9 C, Royal Liverpool University Hospital, Liverpool L7 8XP, UK. Email: Abakran{at}rlbuh\|[hyphen]\|tr.nwest.nhs.uk Back

References

  1. Greenfield DH, McMullan GK, Parisi AF, Askenazi J. Snare retrieval of a catheter fragment with inaccessible ends from the pulmonary artery. Cathet Cardiovasc Diagn1978; 4: 87–90[ISI][Medline]
  2. Marcy PY, Magne N, Bruneton JN. Strecker stent migration to the pulmonary artery: long-term result of a ‘wait-and-see attitude’. Eur Radiol2001; 11: 767–70[ISI][Medline]




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