ABSTRACT
Background: Venous stents are small mesh tubes used mostly for SVC stenosis, SVC syndrome, May-Thurner syndrome and to a lesser extent for IVC obstruction/stenosis. Even though this procedure can relieve obstruction, it has been associated with a wide variety of complications such as thrombosis, migration, obstruction and fracture. Limited guidelines exist about the use of such stents in the IVC. We present a rare case of IVC stent migration causing RA-AO fistula in a 56 year old female. Case: 56 year old female with a history including Autoimmune thyroiditis, hepatitis, breast cancer, recurrent VTE on warfarin found to have IVC stenosis leading to IVC BMS stent 24 x 70mm Wallstent placement in March 2021 after a new DVT was found while on warfarin, switched to Xarelto, COVID pneumonia in august with SOB with a workup showing extension of the IVC stent to the right atrium. Her fatigue and SOB was initially attributed to COVID pneumonia and she was scheduled to have a repeat TTE as outpatient to follow up on the stent. She continued to have worsening SOB and fatigue even after recovering from COVID PNA. Decision-making: Repeat TTE showed severe MR that was not present before and confirmed the presence of the IVC stent in the RA. TEE showed right atrial-aortic cusp fistula attributed to IVC wallsent extending from RA to Aorta leading to high output state and therefore severe MR carpentier IIIb. The patient was admitted to the hospital where a surgical intervention was entertained, she had LHC and RHC that showed normal coronaries with severe Pulmonary hypertension and Qp/Qs: 1.89. Surgical consultation was obtained and she underwent patch repair of aortic fistula with partial IVC stent removal and MV and TV repair. Conclusion: An arteriovenous fistula involving the coronary arteries and the aorta is rare. Even though IVC stents have the potential to alleviate symptoms caused by large narrowed veins, It is important to recognize complications caused by such stents especially in a patient with new Symptoms of heart failure and Valvular regurgitation as an Iatrogenic cause that requires prompt surgical consultation and intervention.