Percutaneous Retrieval of an Intravascular Foreign Body in the Left Atrium Via a Transpulmonary Arteriovenous Malformation Approach

Abstract

To the Editor Pulmonary AVMs can cause serious respiratory and neurologic complications. Close to 90% of PAVMs are associated with hereditary hemorrhagic telangiectasia (HHT), with 30% of patients with HHT developing PAVMs [1]. Transcatheter embolotherapy (TCE) is a safe, efficient, and established procedure used in the management of PAVMs [2]. TCE has been shown to reduce the rate of complications, such as stroke and brain abscess, in patients with PAVMs. A rare complication of TCE is the migration of embolic coils through a PAVM into the left atrium [3–5]. Endovascular retrieval is considered the therapy of choice for misplaced intravascular objects [6]. Endovascular retrieval of foreign bodies from the left atrium is a challenge because of the difficulties in gaining access to the left atrium. There have been few reports on foreign body retrieval from the left side of the heart, and none have used our retrieval approach [3–5, 7, 8]. We describe a unique case in which we successfully retrieved an embolic coil fragment that had migrated through a PAVM to the left atrium using a novel trans-PAVM approach to gain access to the left atrium and a neurovascular snare to retrieve the foreign body. Case Report