Vascular Stent Fracture and Migration to Pulmonary Artery during Arteriovenous Shunt Thrombectomy

Outflow vein stenosis is one of the commonest complications of both native and prosthetic vascular access. Together with angioplasty, first-line treatment is stenting. Although it has been described as a uncommon complication, the risk of stent migration should be always considered. We aimed to conduct a systematic review of literature concerning stents migration in vascular access, the possible outcomes and treatments. This study was performed applying Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Searches were conducted in PubMed/Medline, Scopus, and Google scholar databases. Studies selection, data abstraction was done by two different reviewers. We identified 17 studies, comprising 18 cases (M:F 1:1, mean age 56 ± 18 (range 33–88)). All the patients underwent stenting for vascular access outflow stenosis. The commonest type of device reported was self expandible bare-metal stent. Intraoperative evidence of stent migration occurred in six cases at the final quality control, or for intraprocedure dyspnea onset. In two patients it was a incidental diagnosis. In the remaining cases, chest pain or dyspnea were the common delayed presentation symptoms. Even if stent migration is an uncommon event, it is burdened with low mortality and morbidity. Literature provide only few and frequently inadequate data. Stent removal is the treatment of choice when severe symptoms or cardiopulmonary complication are present. Endovascular procedures demonstrated to be an effective and safe alternative, while open surgical treatment is preferred whenever endovascular therapy failed or in selected cases.

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“…femoral vein CVC) must be considered for those patients. Ho et al 16 describe stent fracture and migration following recurring thrombectomies.…”

Section: Discussionmentioning

confidence: 99%

Stent migration as complication of endovascular treatment of vascular access stenosis: A systemic review

et al. 2022

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“…These cases may lead to embolization, infection, cardiac damage, or even death. [ 8 – 11 ] The common types of these FB are needles, [ 5 ] intravenous cannulas, [ 4 ] guidewires, [ 12 ] stents, [ 13 ] inferior vena cava filter struts, [ 14 ] and other objects (see Table 1 ). [ 6 , 7 , 15 , 16 , 17 – 19 ] However, being a rare pathogenic factor, the more unconventional non-iatrogenic FB often requires more extensive treatment and diagnosis.…”

Section: Discussionmentioning

confidence: 99%

A foreign body in the cephalic vein

Song

Wei²,

Song³

et al. 2018

Medicine

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“…A retrospective image review suggested that the stent may have migrated within 2 months after its insertion; stent migration was identified late because serious acute complications, such as cardiogenic shock, RV rupture, TV injury, and arrhythmia, did not occur. Although stent migration is a rare complication of stent placement that can occur at the time of placement or later, a vascular stent inserted into a central vein stenotic lesion should be periodically monitored for migration 2)…”

mentioning

confidence: 99%