NYMC Faculty Publications

Dual Stent Migration to the Heart and Pulmonary Artery

Author Type(s)

Faculty

DOI

10.1097/MJT.0b013e3182785fc3

Journal Title

American Journal of Therapeutics

First Page

199

Last Page

203

Document Type

Article

Publication Date

1-1-2014

Department

Medicine

Keywords

Adult, Arteriovenous Shunt, Surgical, Female, Foreign-Body Migration, Heart, Humans, Kidney Failure, Chronic, Prosthesis Failure, Pulmonary Artery, Renal Dialysis, Stents

Disciplines

Medicine and Health Sciences

Abstract

The practice of intravascular stenting largely grew out of the concept of stenting the coronaries in acute myocardial infarction. According to the recent United States Renal Data System data registry, there has been a significant increase in endovascular intervention (1.8-fold increase-from 52,380 to 98,148) with a 2.2-fold increase in stent deployment in hemodialysis access (3792-8514). With the increasing use of endovascular stents in the management of dialysis access stenosis, the incidence of stent-related complications has increased significantly. Stent-related complications include stent restenosis, thrombosis (narrowing of the vessel lumen and being a nidus for thombus formation), stent shortening, stent fracture, stent infection, and stent migration. Physiologic variation in the diameter of veins due to respiration, which along with the geometry of the stent, can lead to a shortening lengthening of the stent-resulting in poor wall contact or high-speed impact of shock; in the case of trauma, mechanical bucking can result in tortuous blood vessels thereby resulting in stent migration (however proving this association was not the aim of this article). We report a case of a 44-year-old female with end-stage renal disease on hemodialysis, with stent placement to treat a compromised arteriovenous graft. There have been many cases of stent migration in the past; however, this is the first case of dual stent migration to the heart and pulmonary artery from an unusual (lower extremity) arteriovenous graft location.

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