Migration and Surgical Retrieval of An Amplatzer Septal Occluder Into Abdominal Aorta

Nicolás Maldonado Fernández, Cristina López Espada, Jose Patricio Linares Palomino, Pablo Pérez Vallecillos, Vicente García Róspide
Annals of Vascular Surgery 2020 June 2
32502671

BACKGROUND: Structural heart defects, secondary to congenital malformations, have been commonly repaired by open cardiac surgery. Endovascular technology enables these repairs to be performed with fewer complications and better recovery. However, endovascular therapy can be associated with major complications as device dislocation or embolization. We present the case of migration of an amplatzer occluder device into the abdominal aorta and its surgical retrieval.

CLINICAL CASE: A 10-year-old child with ostium secundum-type interatrial communication underwent endovascular repair in our centre. Cardiologists sorted out the atrial communication by endovascular deployment of an amplatzer device. The 24-hour ultrasound control study showed the loss of the occluder. An angio-CT scan showed the migration of the amplatzer into the juxtarenal abdominal aorta. Initially, an endovascular rescue was attempted, but was not effective. Our vascular team performed a median laparotomy, control of the abdominal aorta proximal to the renal arteries, control of the renal arteries and the infrarenal aorta. We performed a transverse arteriotomy and the material was removed. Subsequently, the arteriotomy was closed directly without any patch. Postoperative evolution was uneventful.

COMMENTS: Most of the migrations and embolizations of the devices to close interatrial communications remain intracardiac. Although embolization of the abdominal aorta is only reported sporadically, it could cause a major vascular complication. Percutaneous retrieval of the device is currently recommended, with conventional surgery being the efficient treatment in case of endovascular failure or severe damage to the aorta.

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