Small bore access for percutaneous retrieval of a patent foramen ovale occluder migrated to the abdominal aorta: how to snare it matters

Migration of a cardiac occluder is one of the most feared complications of endovascular therapy for interatrial defects. A 54-year-old female, after experiencing relapsing cryptogenic embolic cardiac ischaemia without coronary lesions, underwent percutaneous patent foramen ovale (PFO) occlusion with the placement of an Amplatzer Talisman. The next day, a scheduled check detected an early asymptomatic migration of the device to the abdominal aorta. A percutaneous attempt involving interventional radiologists was chosen. Through the common femoral artery, the right atrial screw was targeted and snared. The PFO occluder was thus easily unsheathed utilizing a sheath-in-sheath technique. Endovascular retrieval was successfully performed through an 11 F introducer. This case reminds us that migration is a potential complication of any atrial septal endovascular occlusion and shows that retrieval may be percutaneously accomplished with a small bore introducer.