Intracardiac Venous Stent Migration: Emergency Department Presentation of a Catastrophic Complication

Venous thromboembolism is associated with significant morbidity and mortality if left untreated. Anticoagulation is the cornerstone of treatment. Venous stents are a relatively newer entity that are increasingly being used to treat venous stenosis/occlusion. It is a safe procedure, but complications include vein rupture, arterial puncture, retroperitoneal bleeding, and in-stent thrombosis. Stent migration is a rare but potentially fatal complication. We present a case of venous stent embolization to the heart that presented as a non-ST segment elevation myocardial infarction.

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“…Possible causes of stent embolization include undersizing of the stent, balloon failure, and poor insertion technique. 7 …”

Section: Discussionmentioning

confidence: 99%

Stent Embolization Mimicking Acute Myocardial Infarction

Huda

Kahlown

Pathmanathan

et al. 2021

Journal of Investigative Medicine High Impact Case Reports

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“…Considering venodilation up to 100% (Keiler et al, ), the diameters of valve implants should ideally be adaptive in some way. In the light of this, the post mortem FVDs reported here suggest minimal diameters for individual implants, which to preclude implant migration or embolization should not be smaller (Orellana‐Barrios et al, ; Steinberg et al, ). Conversely, to prevent the risk of unfavorable events such as intimal hyperplasia due to mechanical distension of the vessel, the (static or adaptive) valve implant should not exceed a certain individual diameter (Chen et al, ).…”

Section: Discussionmentioning

confidence: 99%

Human Femoral Vein Diameter and Topography of Valves and Tributaries: A Post Mortem Analysis

et al. 2018

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The femoral vein (FV) is a clinically important vessel. Failure of its valves can lead to chronic venous insufficiency (CVI) with severe manifestations such as painful ulcers. Although they are crucial for identifying suitable implant sites for therapeutic valves, studies on the topography of FV tributaries and valves are rare. Moreover, the femoral vein diameter (FVD) must be known to assess the morphometric requirements for valve implants. To reassess the anatomical requirements for valve implants, 155 FVs from 82 human corpses were examined. FVDs and tributary and valve topographies were assessed using a laboratory straightedge. The FVD increased from 6 mm in the distal femoropopliteal vein to 11 mm in the iliofemoral vein proximal to the saphenofemoral junction (SFJ). Diameters were significantly bigger in males than females. Height correlated positively with FVD. Distal to the SFJ, within a distance of 38 cm, one to eight valves were present. Up to two valves were present within 10 cm proximal to the SFJ. Individual tributary and valve topography must be considered to ensure appropriate design and successful implantation of a venous valve for CVI therapy in the FV. A suitable implant site would be proximal to the SFJ via an infrainguinal transfemoral access. Clin. Anat. 31:1065–1076, 2018. © 2018 Wiley Periodicals, Inc.

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“… 1 Therefore, only a few exceptional cases of stent migration after iliofemoral vein stenting have been reported. 4 5 More frequently, cases of venous stent migration have been reported for the nutcracker syndrome whereby a smaller stent is placed in the left renal vein. 6 One case of a 55-year-old woman ended fatally after transvenous migration of an infrarenal inferior vena cava stent into the right atrium and through the intraatrial septum due to ventricular fibrillation.…”

Section: Discussionmentioning

confidence: 99%

“… 6 One case of a 55-year-old woman ended fatally after transvenous migration of an infrarenal inferior vena cava stent into the right atrium and through the intraatrial septum due to ventricular fibrillation. 4 …”

Section: Discussionmentioning

confidence: 99%