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. 2022 Jul 27:9:954443.
doi: 10.3389/fcvm.2022.954443. eCollection 2022.

Migration of covered stents in thoracic central vein obstruction procedures in patients with hemodialysis: Case report and literature review

Bo Chen  1 , Qiquan Lai  2 , Swalay Fedally  3 , Ziming Wan  2
Affiliations

Migration of covered stents in thoracic central vein obstruction procedures in patients with hemodialysis: Case report and literature review

Bo Chen et al. Front Cardiovasc Med. .

Abstract

Objective: The objective of the study is to present a case of hemodialysis in which the covered stent that had migrated into the right ventricle was retrieved by exploratory thoracotomy, and to review the literature on the diagnosis and treatment of stent migration in thoracic central vein obstruction (TCVO) procedures for hemodialysis patients.

Method: A systematic search of the PubMed database was performed to identify clinical presentations, imaging strategies, stent types, and treatment modalities for stent migration in hemodialysis patients.

Results: A total of 14 case reports on stent migration in TCVO procedures for hemodialysis patients were included and analyzed. Ten cases included migration to the cardiac chambers and the remainder migration to the pulmonary artery. The common symptoms of stent migration in TCVO procedures are reported to be chest pain and dyspnea, while three of the cases studied involved no symptoms. Echocardiography, chest X-ray, and computed tomography are the commonly used methods for the diagnosis of stent migration and identification of the precise positioning of the stent. Stent migration to the right subclavian or innominate veins was the most prevalent case (seven cases). All were bare stents. Seven cases involved retrieval by interventional surgery, while four cases involved retrieval by open heart surgery. However, there were three cases in which the "wait-and-see" approach was adopted since the patients were asymptomatic.

Conclusions: Stent migration in TCVO procedures is a rare but extremely serious complication. The causes are not fully understood. The current treatment strategies include interventional surgery, open heart surgery, and the "wait-and-see" approach.

Keywords: hemodialysis; literature review; stent displacement; stent migration; thoracic central vein obstruction.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Imaging data and intraoperative data of the patients: (a) stenosis (red arrow) of the confluence of the right subclavian vein and the innominate vein in a digital subtraction angiography examination, (b) stent (red arrow) placement in central vein stenosis, (c) transthoracic echocardiography showing pericardial effusion and a stent (red arrow) in the right ventricle, (d) transesophageal echocardiography indicating a segment of stent migration (red arrow) in the right ventricle, (e) the tail of the stent (yellow arrow) was found to have been inserted into the atrial wall during the operation, and (f) a retrieved covered stent.
See this image and copyright information in PMC

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