Successful Retrieval of a Drifting Dislodged Leadless Pacemaker From the Left Common Iliac Artery

Leadless pacemakers (LPs) have become increasingly popular alternatives to conventional transvenous systems because they eliminate leads and generator pockets, reducing the risks of infection, lead fracture, and venous thrombosis. Large multicenter studies have shown lower overall complication rates and fewer reinterventions compared to traditional pacemakers. Despite these advantages, LPs are not free from risk. Migration or embolization of the device is an exceptionally rare but potentially life-threatening complication that requires prompt recognition and intervention. Most reported migrations involve the pulmonary vasculature; arterial migration is exceedingly uncommon. We report the case of a 79-year-old woman with a history of atrial fibrillation and sinus pauses who was found to have imaging evidence of a foreign body in the left common iliac artery. Seven weeks earlier, she had undergone LP implantation. She was asymptomatic and hemodynamically stable on presentation. Computed tomography of the abdomen and pelvis revealed a 3-cm metallic density in the distal left common iliac artery. The patient underwent open retroperitoneal exploration with retrieval of the migrated pacemaker and removal of an associated thrombus, followed by primary arterial repair. Her postoperative course was uneventful, and she was discharged home on postoperative day 4 with intact distal perfusion. Migration of an LP into the arterial circulation is exceptionally rare, with only isolated cases reported in the literature. Early identification and timely surgical intervention are essential to prevent ischemic complications. This case underscores the importance of maintaining vigilance after device implantation and demonstrates that open surgical retrieval with primary arterial repair can be performed safely and effectively. Multidisciplinary collaboration between cardiology, vascular surgery, and radiology is crucial in managing these rare complications.