An uncommon complication of coil embolization: Coil deployment system malfunction leading to retained intra-aortic...

Management of upper gastrointestinal (GI) bleeding is well-studied, with current guidelines recommending endoscopic evaluation with intervention, followed by angiography and embolization as an adjunct procedure for recurrent bleeding. Complications related to angiography and coil embolization are well-reported in the literature, including coil migration, recurrent bleeding, and need for reintervention, among others. We present the case of a 52-year-old woman who presented with an acute submassive pulmonary embolism with right heart strain and a concurrent nonvariceal upper GI bleed. The patient underwent pulmonary embolectomy, upper endoscopy, and subsequent selective gastroduodenal artery (GDA) embolization. Owing to recurrent upper GI bleeding, the patient underwent a repeat selective GDA embolization. During deployment of the second embolization coil, the deployment wire was severed at the deployment handle, leading to a retained intra-aortic wire extending proximally from the coil in the GDA to the external iliac artery. Although initial plans included wire retrieval, a multidisciplinary team decided against it owing to the patient's clinical status and high risks associated with retrieval, namely, concerns for arterial injury, embolization of the coils to other arteries, and anesthesia-related complications.