Objective
Venous stent migration to the heart is a potentially life-threatening complication and has recently led to device withdrawal from the market. A review of the literature was conducted to better characterize factors associated with this serious complication and its management.
Methods
A systematic review of the literature using the term “venous stent migration” was performed. All articles describing patients with this complication were reviewed. Patient characteristics, indication, time to discovery of migration, and management were summarized. Venous stents that migrated from the lower body to the heart were compared with venous stents that migrated from the upper body.
Results
A total of 73 papers with 84 patients reported venous stent migration to the heart or through the heart to the pulmonary artery. The number of papers reporting this phenomenon increased from 6 in the period of 1991-1995 to 20 in the period of 2016-2020 (Fig). The incidence of venous stenting migration varied mostly between 0.4% and 4.5%. Patients with migration from lower body were significantly younger (49.1 vs 56.9, P = .05). There were significant differences in indications for stenting with most patients with upper body migration being treated for dialysis access maintenance while patients with lower body migration treated for venous insufficiency/thrombosis (P < .001). Of the cases of venous stent migrations from lower body, 20% (8 of 41) were due to Nutcracker syndrome as an indication. There was no difference in stent characteristics in terms of type (86% self-expanding) or size. The implanted stents were relatively small (mean diameter = 14 mm) and short (mean length = 4.5 mm). After venous stent migration, most patients presented with symptoms (60%), with no difference in mean time to presentation. Patients with upper body stent migration were significantly more likely to be treated with no surgery or endovascular intervention compared with those with lower body stent migration, which was more likely to be treated with an open surgery (P = .014) (Table). At least 12% (n = 3 of 25) of patients requiring open surgery required valve replacement. The overall mortality related to stent migration to the heart was 3.6% (n = 3 of 84).
Conclusions
There is a rise in reporting of venous stent migration to the heart in the literature. Stent migration from the lower body seems to be less amenable to endovascular therapy compared with migration from the upper body. This complication carries significant mortality likely in excess of 3.6% because of underreporting.
