Transcatheter retrieval of Amplatzer Septal Occluder device embolized into the abdominal aorta

Abstract

The use of Amplatzer Septal Occluder device has become an alternative to surgical procedure in selected group of patients affected by atrial septal defect. Percutaneous closure of atrial septal defect has emerged as a low morbidity procedure but, at the same time, showed various complications associated to the device itself. Although embolization to the abdominal aorta is only sporadic reported, it could represent a potential vascular disaster and usually is treated by surgery. Herein, we report on the fourth, in English literature, successfully total transcatheter retrieval of an Amplatzer Septal Occluder device complicated by acute embolization into the abdominal aorta and propose a practical endovascular manoeuvre to address disc removal.

Percutaneous closure of atrial septal defect: a consensus document of the joint group of experts from the Association of Cardiovascular Interventions and the Grown-Up Congenital Heart Disease Section of the Polish Cardiac Society

“…Device dislodgement Device dislodgement, with subsequent embolization, occurs usually within 24 to 48 hours after the procedure with the incidence rate of 0.2% to 1.67%. 71,82,84,[86][87][88][89] However, it can also occur sporadically within several months or later after ASD closure. 71,89 The most common reasons for occluder dislodgement are a thin and aneurysmal septum, an inadequate results concerned complication types and rates.…”

“…89 It should be emphasized that all operators who perform percutaneous ASD closure should be prepared for percutaneous device retrieval in the event of device embolization. 88 Cardiac perforation and erosion Cardiac perforation, which is mostly a catheter -related injury during the procedure, is a very rare complication (0.1%) manifesting usually as cardiac tamponade. 88 It requires immediate heparin neutralization and decompression by pericardial puncture.…”

“…88 Cardiac perforation and erosion Cardiac perforation, which is mostly a catheter -related injury during the procedure, is a very rare complication (0.1%) manifesting usually as cardiac tamponade. 88 It requires immediate heparin neutralization and decompression by pericardial puncture. If intrapericardial bleeding persists, surgical intervention is required.…”

“…In an Amplatzer or Amplatzer--like device, pulling out is usually feasible by grabbing a female screw site of the right atrial days, or even years later. [86][87][88]92,96 Risk factors include young age and large defect / device size. Generally, it is believed to be caused by compression of the AV node or inflammatory reaction to a foreign body and scarring at the level of the triangle of Koch caused by the device.…”

“…84,89 Only few cases required surgical removal of thrombus. 88,93 Although antiplatelet therapy has been recommended for 3 to 6 months after the procedure, the time frame of thrombus formation ranged from 4 weeks to 7 years after implantation. Early neurological complications after transcatheter ASD closure can be resolved by heparin infusion.…”