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Migration of superior vena cava stent

DOI: 10.1186/1749-8090-3-12

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Abstract:

There has been a recent increase in the use of endovascular prostheses resulting in complex surgical and interventional complications not previously recognised. We report a case of Superior Vena Cava Stenosis treated with a Wallstent which migrated to the right atrium, necessitating a combined radiological and surgical approach to retrieve it.A 78 year old haemodialysis patient was admitted under the care of renal team with a history of symptomatic bilateral upper limb and facial swelling unrelated to her renal impairment. In the past, her right groin had been irradiated for lymphoma and she had significant co-morbidity precluding any surgical intervention. She had duplex scanning, which showed evidence of Superior Vena Caval obstruction. She underwent angioplasty and Stenting of the Superior Vena Cava with a 10 mm × 46 mm Wallstent Uni endoprosthesis (Boston Scientific Corp., MA, USA). A right Internal Jugular Vascath was inserted proximal to the stent and good flows were achieved from all three lumen.Two weeks later since her supracaval venous access became blocked and a tunnelled Permacath was placed in the left femoral vein. An Amplatz superstiff wire was placed across the SVC stent through the pre-existing vascath. Under fluoroscopy, the line was removed and a peel-away sheath was introduced over the wire, to facilitate the introduction of a tunnelled Split-Cath. The intersect between the two different length lumina caught on the superior margin of the SVC stent instantly dislodging it. The stent moved into and lay horizontally in the right atrium [Fig 1, 2].A 45 cm 10 Fr SuperArrow-flex percutaneous sheath was inserted in the left femoral vein, immediately superior to the tunnelled split-cath. Through this a 25 mm Amplatz gooseneck snare (ev3 Inc, MI, USA) was inserted and several futile attempts were made to snare the stent. A sidewinder catheter (Cordis Europa N.V) over an angled Terumo wire (Terumo Corp, Japan) was used to access the lumen of the stent. The

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