An affordable approach for the extraction of migrated foreign devices into pulmonary arteries

Abstract

Percutaneous embolization of the hypogastric and gonadal veins represents an effective treatment of pelvic venous congestion syndrome. In rare cases, coil migration may occur. We are presenting the case of a 57-year-old female patient diagnosed in 2013 with pelvic congestion syndrome, treated by a transcatheter coil embolization technique of the gonadal and hypogastric veins. During the procedure, one coil migrated to the right inferior pulmonary lobe artery leading to localized thromboembolism. Four years after the intervention, the patient addressed our Cardiology Department for an attempt of coil extraction. A minimally invasive percutaneous endovascular technique through the right subclavian vein was performed. The reason for the few cases reported regarding the percutaneous extraction and the limited experience in this field is assumed to be due to the absence of clinical expression induced by the migrated coils, most patients being asymptomatic. The management of coil migration in asymptomatic cases is a controversial issue. In the presented case, our patient had two thrombotic events induced by the migrated coil. So, a percutaneous attempt was performed for its extraction since our patient needed long-term oral anticoagulation therapy. The procedure didn’t succeed but showed the fact that percutaneous extraction of pulmonary artery migrated coil could be feasible in those symptomatic cases with recent occurred migration using affordable devices.