Embolization of a Stent from an Arteriovenous Graft Into the Right Ventricle in a Patient on Chronic Hemodialysis

Abstract

Figure. Embolized stent attached to tricuspid valve: (a) four-chamber echocardiographic view, (b) fluoroscopic view, and (c) intraoperative view. E mbolization of a venous stent is a rare but potential-ly catastrophic complication of peripheral vascular intervention. We report a case of a woman with chronic kidney disease who had recently received an endovas-cular stent to treat a compromised arteriovenous graft. While cases of stent embolization have been reported with other applications, this case represents the fi rst reported proximal embolization of an arteriovenous dialysis graft stent. With the potential increase in utilization of percutaneous intervention to manage dialysis graft failure, the incidence of this complication will likely increase (1). CASE REPORT A 60-year-old white woman with end-stage renal disease on hemodialysis, prior myocardial infarction, and diabetes mellitus presented to the emergency department after a fall. Th e patient did not recall the events preceding the fall. She had multiple vas-cular access issues and had undergone multiple thrombectomies and venous stent placements. Approximately 1 month earlier, a stent was placed in her right basilic vein after an angiogram revealed a >80% diameter stenosis that was compromising her graft. Th e stent was deployed successfully and the procedure was tolerated well. A transthoracic echocardiogram revealed a massively dilated right ventricle with a right ventricular systolic pressure of 95 mm Hg, severe tricuspid regurgitation, and a cylin-drical metallic mass adherent to a tricuspid valve papillary