Vascular Case Presentation embolized stent modified

Vascular Case Presentation : 

Vascular Case Presentation Mr.Mohamed Omar El-Farok M.Sc, FRCS

Stent in The Right Ventricle : 

Stent in The Right Ventricle What To Do ?

Case Profile : : 

Case Profile : 1. Case ID 2. Center 3. Operators 4. Type of procedure : 5.Difficulty level 233 IDE National Diabetic Inst. Mr.M.O.Elfarok/Mr.bishara Peripheral Venous Complex

Clinical History : 

Clinical History Male patient 56 years. Chronic Renal Failure on dialysis had A-V shunt bracheo- cephalic right arm one week ago C/O severe right arm swelling after the shunt

Investigations : : 

Investigations : Duplex : right upper limb is Normal Venogram : Right subclavian vein stenosis

Venogram : : 

Venogram :

Intended strategy : Plan 1 : 

Intended strategy : Plan 1

Intended strategy : Plan 2 : 

Intended strategy : Plan 2

Failed :Plan 1 : 

Failed :Plan 1

Succeded Plan 2 : 

Succeded Plan 2

Balloon dilatation failed : 

Balloon dilatation failed

Stent precise control 12mm*60 : 

Stent precise control 12mm*60

Stent embolized to R.Ventricle : 

Stent embolized to R.Ventricle ؟

What we have gut : 

What we have gut

Options : : 

Options : Suicide Jump from the window Screem for 48 hours or Think

Advise from colleagues : 

Advise from colleagues Dr. Ahmed Khashabe Ain Shams University Dear Dr. Omar I hope you are doing fine. One solution we sometimes do with embolized stents is to drive to the most distal vascular bed and deploy them where they can reach. This maintains the blood flow to the vascular bed and avoids the patient unnecessary surgery. Happy Eid to all of you Ahmed Khashaba

This is what happened : 

This is what happened Stenting the right subclavian v.

Snair the distal end of the stent : 

Snair the distal end of the stent Snair by angiodynamics using 4 mm 125 cm shaft

Another snair from left fem vein : 

Another snair from left fem vein

Stent pulled till the left leg : 

Stent pulled till the left leg

Two snair technique : 

Two snair technique

Take home message : 

Take home message

Lesson in life : 

Lesson in life To simplify complications is the first essential of success. - George Earle Buckle Historian

Thank You : 

Thank You