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Explanting the migrated hepatic stent in the right atrium by modified vena caval inflow occlusion
Manoras Mathew Chengalath1, Thomas Mathew1, Lijesh Kumar2
1Department of Cardiothoracic Surgery, Lisie Hospital, Cochin, India.
Insights
Hepatic vein stenting offers a lasting solution for Budd-Chiari syndrome. A novel technique using balloon occlusion of the inferior vena cava successfully retrieved a migrated stent, avoiding cardiopulmonary bypass.
Area of Science:
- Interventional cardiology
- Vascular surgery
Background:
- Budd-Chiari syndrome can necessitate hepatic vein stenting.
- Stent migration to the right atrium is a rare but serious complication.
- Surgical retrieval of migrated stents often requires cardiopulmonary bypass (CPB).
Observation:
- A case of hepatic vein stent migration into the right atrium is presented.
- Conventional retrieval methods carry risks associated with CPB and circulatory arrest.
Findings:
- A hybrid technique employing vena caval inflow occlusion (VCIO) using a balloon catheter was utilized for stent retrieval.
- This method successfully occluded the inferior vena cava, facilitating stent retrieval.
- Cardiopulmonary bypass and total circulatory arrest were avoided during the procedure.
Implications:
- This hybrid VCIO technique offers a viable alternative for managing migrated hepatic vein stents.
- It potentially reduces the risks and complications associated with traditional CPB-dependent retrieval.
- This approach may improve patient outcomes in rare cases of stent migration.
Abstract:
Stenting of hepatic veins can be a long lasting solution for Budd-Chiari syndrome. These stents could very rarely migrate into the right atrium. During surgical retrieval, cardiopulmonary bypass (CPB) can be avoided if vena caval inflow occlusion (VCIO) is used. A hybrid alternative of VCIO by using a balloon to occlude the inferior vena cava was done to retrieve the stent thus avoiding CPB and total circulatory arrest.
