Delayed Retrieval of a Patent Foramen Ovale Occluder From the Abdominal Aorta: Management and Challenges

Patent foramen ovale (PFO) closure is an established strategy to prevent recurrent stroke from paradoxical embolism. Occluder embolization is a rare but serious complication.

A 55-year-old man presented with abdominal discomfort 6 months post PFO closure. Transthoracic echocardiography failed to visualize the occluder, and a computed tomography scan revealed device embolization into the abdominal aorta. The patient underwent percutaneous retrieval of the device coupled with repeat PFO closure. Although the procedure was technically successful, he developed type B aortic dissection, which was successfully managed conservatively.

Delayed retrieval of a PFO occluder embolized into the aorta is associated with significant risk of aortic injury, regardless of endovascular or surgical approach.

Adequate PFO sizing is critical to prevent device embolization. When endovascular retrieval is necessary, the use of a long sheath 2- to 5-F sizes larger than the original introducer is recommended.