title: Vascular stent fracture and migration to pulmonary artery during arteriovenous shunt thrombectomy.
abstract: OBJECTIVE
  Endovascular stent fracture and migration is an extremely rare complication of arteriovenous shunt thrombectomy.
  
  
  METHODS
  We report a case of endovascular stent fracture following repeat arteriovenous graft thrombectomy, which was complicated by migration of a 26 millimeter stent fragment to the left main pulmonary artery. Attempts at percutaneous transvenous retrieval were unsuccessful, and an open thoracotomy to extract the stent fragment was performed.
  
  
  CONCLUSIONS
  Although there is no consensus for the management of endovascular stents that have migrated to the pulmonary arteries, stent retrieval may be necessary in cases where arterial flow is compromised or heavy clot burden is a concern. Moreover, steps toward prevention of stent fracture and migration should be considered in order to preclude such occurrences--avoidance of puncturing the stent for hemodialysis access, discontinuation of use of the Arrow-Trerotola device through or near stents, and consideration of short segment angioplasty for regional intrastent stenosis rather than typical long segment venous angioplasty.
authors.affiliation: Department of Radiology, St. Luke's Roosevelt Hospital Center, New York, NY 10019, USA. jho@chpnet.org
authors.forename: Jessica M
authors.initials: JM
authors.lastname: Ho
authors.forename: Jonathan
authors.initials: J
authors.lastname: Kahan
authors.forename: Azhar
authors.initials: A
authors.lastname: Supariwala
authors.forename: James
authors.initials: J
authors.lastname: Silberzweig
authors.forename: Robert
authors.initials: R
authors.lastname: Kornberg
authors.forename: Daniel
authors.initials: D
authors.lastname: Swistel
authors.forename: Ronald
authors.initials: R
authors.lastname: Dreifuss
mesh_terms: D017130:Angioplasty / Q000009:adverse effects / Q000295:instrumentation*; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects*; D001916:Brachial Artery / Q000601:surgery; D020878:Device Removal; D005548:Foreign-Body Migration / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D006083:Graft Occlusion, Vascular / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy; D008297:Male; D008875:Middle Aged; D011475:Prosthesis Failure; D011651:Pulmonary Artery / Q000000981:diagnostic imaging / Q000601:surgery; D011859:Radiography; D006435:Renal Dialysis; D012086:Reoperation; D015607:Stents; D013908:Thoracotomy; D017131:Thrombectomy; D013927:Thrombosis / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D016896:Treatment Outcome; D034941:Upper Extremity / Q000098:blood supply*; D014680:Veins / Q000601:surgery