Intracardiac Migration of a Right Common Iliac Vein Stent: A Silent Complication Detected by Multimodality Cardiac Imaging

Presenting Author(s)

• 

  Gabriel Amaral Mendes Ferreira, MD

  Cardiologist
  Universidade Federal de São Paulo - Unifesp/ DASA
  Sao Paulo, Sao Paulo, Brazil

Primary Author(s)

• 

  Gabriel Amaral Mendes Ferreira, MD

  Cardiologist
  Universidade Federal de São Paulo - Unifesp/ DASA
  Sao Paulo, Sao Paulo, Brazil

Co-Author(s)

• GG

  Guilherme Martins Guzman

  Cardiologistgis
  Hospital 9 de Julho, Brazil
• MC

  Marcia de Paula Cardinali

  Cardiologistgist
  DIAGNÓSTICOS DA AMÉRICA S.A., Brazil
• 

  Maira Azevedo Ximenes

  Fellowship in Cardiac Imaging Department DASA + Unifesp
  Universidade Federal de São Paulo - Unifesp
  São Paulo, Sao Paulo, Brazil
• 

  Marly Uellendahl, MD, PhD

  Cardiac Imaging Coordinator
  DASA - UNIFESP
  São Paulo, Sao Paulo, Brazil
• AE

  Alfredo Eyer Rodrigues

  Cardiologist
  Universidade Federal de São Paulo - Unifesp, Brazil
• CP

  Cecilia Maria Pereira Pereira Santos

  Fellowship in Cardiac Imaging DASA-SP
  Universidade Federal de São Paulo - Unifesp
  São Paulo, Sao Paulo, Brazil

Description of Clinical Presentation: A 42-year-old male with a history of deep vein thrombosis of the right external and left common iliac veins, later diagnosed with May-Thurner Syndrome, underwent iliac vein angioplasty in 2017.

In 2024, he was diagnosed with gallbladder adenomyomatosis, requiring cholecystectomy. Preoperative transthoracic echocardiography revealed a hyperechogenic mass within the right atrium (RA), raising suspicion of thrombus or an intracardiac tumor.

Diagnostic Techniques and Their Most Important Findings: Echocardiography showed a fixed, hyperechoic, tubular structure extending from the superior vena cava (SVC) to the vicinity of the tricuspid annulus. There was no evidence of tricuspid valve involvement and no signs of pulmonary hypertension.

Cardiac MRI revealed a well-defined, symmetric, and uniformly hypointense structure, exhibiting a typical “signal void” artifact, consistent with the contour of a metallic device. Homogeneous contrast perfusion confirmed preserved flow within its lumen.

Cardiac and abdominal CT angiography identified a 120 mm fragment in the SVC, with its distal end fractured near the tricuspid annulus, and a 15 mm fragment lodged in the right pulmonary artery, without obstruction. The left common iliac vein stent remained patent, confirming embolization of the right iliac stent.

Review of prior imaging revealed embolization already evident on abdominal CT in 2017, though unreported.

Learning Points from this Case: Venous stenting is a well-established therapy for occlusive disease. A rare but serious complication is the stent migration with reported incidence of 0.9 to 4.3%, and likely underreported. Migration may occur immediately or years later, with a few case articles relating after trauma. Factors that influence migration include stent size, implantation site, and vessel diameter.



Most migrated stents occur in the iliocaval segments and are < 90 mm in length and < 14 mm in diameter. Interestingly, our patient’s embolized stent measured 140 mm, a rare size for migration. Although migration-related complications can be severe, up to 41% are incidentally detected in asymptomatic patients. The heart embolization may cause valvular dysfunction, heart failure and arrhythmia.

Imaging is essential for diagnosis and follow-up. Chest CT and echocardiography are particularly valuable, both for diagnosis and for guiding therapeutic decisions.



The management strategies depend on clinical severity. In a few cases, especially with asymptomatic ones, patients were treated conservatively with anticoagulant or antiplatelet therapy



In this case, endovascular or surgical retrieval was considered, however, given the long-standing embolization, absence of cardiopulmonary compromise and lack of symptoms, conservative management was chosen.



As venous stenting becomes more common, clinicians must remain vigilant for the possibility of migration. This case highlights the important role of multimodality imaging in both the detection and surveillance of stent migration, enabling accurate diagnosis even in asymptomatic patients.

Image 1: Transthoracic echocardiography and cardiac magnetic resonance bSSFP four-chamber view demonstrate a well-delineated intracavitary structure located within the RA, located in close proximity to the tricuspid annulus. Cavity dimensions are preserved.
Image 2: Cardiac magnetic resonance. Left: tubular structure in the SVC with susceptibility artifact extending into the RA (white arrow). Right: single-shot LGE PSIR demonstrating contrast opacification within the stent lumen, consistent with preserved flow (yellow arrow).
Image 3: Computed tomography. Left: 3D CTA reconstruction showing a stent in the left common iliac vein (white arrow), the embolized stent positioned within the RA with a fractured proximal edge and with its distal end lodged in the SVC (white arrowhead) and a small stent fragment located in the right pulmonary artery branch (yellow arrowhead). Upper right: View highlighting the relationship of the stent between the SVC and RA, with evidence of a fractured distal edge (blue arrowhead). Lower right: Axial view at the level of the pulmonary artery showing a metallic fragment in the right pulmonary artery branch (red arrowhead).