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Year : 2020  |  Volume : 4  |  Issue : 1  |  Page : 47-48

Percutaneous endovascular retrieval of a dislodged left atrial appendage closure device from the juxtarenal aorta


1 Department of Medical Imaging, Division of Vascular Interventional Radiology, King Abdulaziz Medical City; King Saud Bin Abdulaziz University for Health Sciences; King Abdullah International Medical Research Center, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
2 King Saud Bin Abdulaziz University for Health Sciences; King Abdullah International Medical Research Center, Ministry of National Guard Health Affairs; Division of Adult Cardiology, King Abdulaziz Cardiac Center, King Abdulaziz Medical City, Riyadh, Saudi Arabia

Date of Submission13-Oct-2019
Date of Acceptance13-Oct-2019
Date of Web Publication12-Dec-2019

Correspondence Address:
Yousof Abdulrahman Al Zahrani
Department of Medical Imaging, Division of Vascular and Interventional Radiology, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh 11426
Saudi Arabia
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/AJIR.AJIR_28_19

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How to cite this article:
Al Zahrani YA, Arabi M, Al Harbi AA, Al Dulaigan E, Al Ghamdi A, Al Moaiqel M. Percutaneous endovascular retrieval of a dislodged left atrial appendage closure device from the juxtarenal aorta. Arab J Intervent Radiol 2020;4:47-8

How to cite this URL:
Al Zahrani YA, Arabi M, Al Harbi AA, Al Dulaigan E, Al Ghamdi A, Al Moaiqel M. Percutaneous endovascular retrieval of a dislodged left atrial appendage closure device from the juxtarenal aorta. Arab J Intervent Radiol [serial online] 2020 [cited 2020 Jul 14];4:47-8. Available from: http://www.arabjir.com/text.asp?2020/4/1/47/272817



We present a 74-year-old male Who is known to have diabetes, hypertension male and paroxysmal atrial fibrillation. A 21-mm Left Atrial Appendage (LAA) Occluder Watchman Device (Boston Scientific, Maple Grove, MN) was implanted 6 months earlier. The patient presented with asymptomatic device migration diagnosed on follow-up cardiac echocardiography. Computed tomography (CT) angiography showed the device lodged at the juxtarenal aorta occluding the right renal artery [Figure 1]a and [Figure 1]b. Abdominal aortography through left brachial access showed the migrated device at the level of the renal arteries [Figure 1]c. Through the right internal jugular vein, an intracardiac echocardiography catheter was advanced to the inferior vena cava to monitor the aortic lumen during the retrieval procedure. Using a 14-Fr sheath (Cook Medical, Bloomington, IN) through the left common femoral artery, the device was captured and removed using alligator forceps [Figure 1]d. Completion aortography showed no extravasation or dissection [Figure 2]a. Femoral access hemostasis was achieved using Prostar ® XL closure device (Abbott Vascular Inc, CA, USA). A follow-up CT angiography 1 month later revealed intact and widely patent abdominal aorta [Figure 2]b, [Figure 2]c, [Figure 2]d.
Figure 1: (a and b) Contrast-enhanced computed tomography scan of the abdomen showing the embolized Watchman device within the juxtarenal abdominal aorta. (c) Conventional abdominal aortography confirming the location of the embolized device (white arrow) and patency of the aorta before retrieval

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Figure 2: (a) Retrieved Watchman device (b) Postretrieval aortography showing patent intact aorta. (c and d) Follow-up computed tomography scan images showing intact aorta with no signs of vascular injury

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LAA occlusion is a nonpharmacological alternative embolic protection in patients with nonvolvular atrial fibrillation.[1],[2] LAA device migration is a rare complication that was reported in less than 4% of cases.[1] LAA closure device migration into the aorta is rare and reported only in seven cases in the literature.[2],[3] Our case demonstrated that percutaneous endovascular retrieval is a safe alternative to major surgery.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Bajaj NS, Parashar A, Agarwal S, Sodhi N, Poddar KL, Garg A, et al. Percutaneous left atrial appendage occlusion for stroke prophylaxis in nonvalvular atrial fibrillation: A systematic review and analysis of observational studies. JACC Cardiovasc Interv 2014;7:296-304.  Back to cited text no. 1
    
2.
Perrotta L, Bordignon S, Dugo D, Fürnkranz A, Konstantinou A, Ricciardi G, et al. Complications from left atrial appendage exclusion devices. J Atr Fibrillation 2014;7:1034.  Back to cited text no. 2
    
3.
Aminian A, Lalmand J, Tzikas A, Budts W, Benit E, Kefer J, et al. Embolization of left atrial appendage closure devices: A systematic review of cases reported with the watchman device and the Amplatzer cardiac plug. Catheter Cardiovasc Interv 2015;86:128-35.  Back to cited text no. 3
    


    Figures

  [Figure 1], [Figure 2]



 

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