Venous Stent Migration to the Heart: An Institution Case Series and Review of the Literature

Objective Iliac venous stent migration to the heart is a rare but potentially life-threatening complication, oftentimes requiring open cardiac surgery and tricuspid valve repair. We present our institution's experience combined with review of the literature and public-facing US FDA databases (total N=88). Methods We identified 2 cases of venous stent migration requiring open cardiac surgery at our institution in the past 10 years. Literature was reviewed from 2005-2024 for key phrases associated with iliac venous stent migration and cardiac complications. The FDA voluntary safety reporting databases MAUDE and MedSun were queried for adverse outcomes related to stent models identified in the literature search and cases of migration to the heart were identified. Results Fifty-six literature cases of venous stent migration to the heart were identified. Migration most involved the right atrium (44%) and right ventricle (48%); 53% required open cardiac surgery (43% after failed endovascular attempts), and tricuspid repair was required in one-third of open cases. There were no deaths among patients who underwent surgical or endovascular treatment; all observed mortality occurred in non-intervention (conservative management) cases (Table 1). Query of FDA MAUDE/MedSun databases identified 30 additional cases with a similar distribution of chamber involvement and management, most frequently involving Zilver and Wallstent devices (Table 2). Conclusions Cardiac migration of peripheral venous stents may cause life-threatening arrhythmia or valvular injury. Stable patients or those at high surgical risk should first undergo attempted endovascular retrieval, while open surgery is preferred for hemodynamic instability or stent entanglement with cardiac valves.