Chen Bo, Lai Qiquan, Fedally Swalay, Wan Ziming
Department of Ultrasonography, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Department of Nephrology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Front Cardiovasc Med. 2022 Jul 27;9:954443. doi: 10.3389/fcvm.2022.954443. eCollection 2022.
The objective of the study is to present a case of hemodialysis in which the covered stent that had migrated into the right ventricle was retrieved by exploratory thoracotomy, and to review the literature on the diagnosis and treatment of stent migration in thoracic central vein obstruction (TCVO) procedures for hemodialysis patients.
A systematic search of the PubMed database was performed to identify clinical presentations, imaging strategies, stent types, and treatment modalities for stent migration in hemodialysis patients.
A total of 14 case reports on stent migration in TCVO procedures for hemodialysis patients were included and analyzed. Ten cases included migration to the cardiac chambers and the remainder migration to the pulmonary artery. The common symptoms of stent migration in TCVO procedures are reported to be chest pain and dyspnea, while three of the cases studied involved no symptoms. Echocardiography, chest X-ray, and computed tomography are the commonly used methods for the diagnosis of stent migration and identification of the precise positioning of the stent. Stent migration to the right subclavian or innominate veins was the most prevalent case (seven cases). All were bare stents. Seven cases involved retrieval by interventional surgery, while four cases involved retrieval by open heart surgery. However, there were three cases in which the "wait-and-see" approach was adopted since the patients were asymptomatic.
Stent migration in TCVO procedures is a rare but extremely serious complication. The causes are not fully understood. The current treatment strategies include interventional surgery, open heart surgery, and the "wait-and-see" approach.
本研究旨在呈现一例通过开胸探查取出迁移至右心室的覆膜支架的血液透析病例，并回顾血液透析患者胸段中心静脉阻塞（TCVO）手术中支架迁移的诊断和治疗相关文献。
对PubMed数据库进行系统检索，以确定血液透析患者支架迁移的临床表现、影像学策略、支架类型及治疗方式。
共纳入并分析了14例血液透析患者TCVO手术中支架迁移的病例报告。10例为迁移至心腔，其余迁移至肺动脉。据报道，TCVO手术中支架迁移的常见症状为胸痛和呼吸困难，而所研究的病例中有3例无症状。超声心动图、胸部X线和计算机断层扫描是诊断支架迁移及确定支架精确定位的常用方法。支架迁移至右锁骨下静脉或无名静脉最为常见（7例）。均为裸支架。7例通过介入手术取出，4例通过心脏直视手术取出。然而，有3例因患者无症状而采取了“观察等待”的方法。
TCVO手术中的支架迁移是一种罕见但极其严重的并发症。其病因尚未完全明确。目前的治疗策略包括介入手术、心脏直视手术和“观察等待”方法。
