Abstract 4367684: The wandering stent: Tricuspid Valve Injury from a Migrated Endovascular Stent

Abstract

Introduction: Endovascular stents are commonly used for vascular access in patients undergoing hemodialysis. While these devices are generally safe, rare but serious complications such as stent migration and associated endocarditis can occur. Migration into cardiac chambers has been reported, often requiring surgical intervention due to the high risk of valvular damage. Case presentation: A 71-year-old male with a medical history of end-stage kidney disease on dialysis and hyperlipidemia, presented with fevers and shortness of breath. On presentation vital signs were notable for tachycardia. Sepsis was suspected, and blood cultures grew Streptococcus gallolyticus, and subsequently started on Ceftriaxone. Echocardiogram revealed a large, migrated endovascular stent in the right atrium, measuring approximately 6 cm × 1.4 cm. Stent appeared to be attached to the anterior leaflet of the tricuspid valve. Left ventricular function ejection fraction was 55%. No vegetations or pericardial effusion were appreciated. Patient reported undergoing an uncomplicated creation of the left arm fistula with vascular stent approximately two years prior. Percutaneous retrieval was attempted twice unsuccessfully. Later, his course was complicated by cardiac tamponade requiring pericardiocentesis, with drainage of approximately 550 mL of sanguineous fluid. This complication was suspected due to myocardial microperforation during the attempted stent retrieval. Following hemodynamic stabilization, the patient underwent cardiac surgery with successful removal of the migrated stent and bioprosthetic tricuspid valve replacement. He then completed a full course of antibiotics for bacteremia and was discharged to a physical rehabilitation facility. Discussion: Stent migration into the heart is a rare but potentially life-threatening complication. It’s commonly associated with improper sizing, placement, or vessel wall degradation over time. Once in the cardiac chambers, stents can cause mechanical damage, serve as a nidus for infection, and impair valvular function. While percutaneous retrieval is typically the first-line approach, surgical intervention is often necessary when complications like tamponade or valve involvement occur. This case calls attention to the importance of long-term monitoring of intravascular devices, especially in patients with dialysis access, and highlights the need and importance for multidisciplinary management when complications arise.