Fluoroscopic and trans-esophageal echocardiographic guided removal of dialysis access stents migrated to the heart and pulmonary artery

Two self-expanding bare-metal stents migrated during a dialysis access intervention at an outside institution. The patient subsequently developed new onset arrythmia. CT demonstrated a migrated stent near the tricuspid valve and another stent in the left pulmonary artery. Multidisciplinary evaluation recommended minimally invasive management due to high surgical risk. Trans-esophageal echocardiography (TEE) guidance was used during percutaneous stent retrieval. The stent was snared within the right ventricle and withdrawn into an intraventricular guiding catheter to protect the tricuspid valve. This system was withdrawn into a long IVC sheath. The sheaths and stent were then removed together, whilst maintaining a transfemoral intravascular guidewire. The same procedure was repeated for the retrieval of the left pulmonary artery stent. The patient was discharged on post-procedure day 2 without complication.