Diagnosis and Management of Inadvertent Iliac Vein Injury During Structural Heart Interventions

Femoral venous access is increasingly used by structural interventional cardiologists in procedures such as patent foramen ovale, atrial septal defect, and left atrial appendage closure, as well as tricuspid and mitral interventions. Containing less muscular and elastic fibers than arteries, veins are fragile structures that are more easily pierced than arteries. In this case series, we present 2 cases of iliac vein perforation during structural cardiology interventions. Even mild resistance on advancement of a large sheath should prompt suspicion of venous perforation, in which case control angiography should be performed at the end of the procedure, after withdrawal of the sheath distal to the suspected perforation site. In case of venous breach, implantation of a peripheral artery-dedicated covered stent can efficiently seal the perforation. This forethought can allow the avoidance of severe complications such as retroperitoneal hemorrhage.