Intracardiac migration of a left renal vein stent after endovascular treatment of nutcracker-associated pelvic congestion syndrome: a case report

BACKGROUND: Left renal vein (LRV) stenting is used in selected patients with symptomatic Nutcracker syndrome (NCS). Stent migration is uncommon but may be serious, particularly in interventions performed primarily for symptom relief. We report intracardiac migration after combined treatment of NCS-associated pelvic congestion syndrome (PCS) and use the event to discuss patient selection, treatment sequencing, and consent in pain-driven venous interventions. CASE PRESENTATION: We report a 37-year-old woman with chronic pelvic pain and imaging findings compatible with nutcracker syndrome and associated pelvic congestion syndrome who underwent left renal vein stenting (self-expanding nitinol stent, 14 × 40 mm) with concomitant left ovarian vein coil embolisation. Fourteen days later, she presented with acute dyspnoea and palpitations. Echocardiography revealed a linear foreign body at the tricuspid valve level with severe tricuspid regurgitation, and computed tomography confirmed stent migration from the left renal vein into the right atrium and ventricle. Endovascular snare retrieval failed because of engagement of the stent struts within the tricuspid apparatus, and surgical extraction under cardiopulmonary bypass with tricuspid valve repair was required. Despite technical success of the venous interventions, pelvic pain did not improve durably. CONCLUSIONS: Intracardiac migration after LRV stenting is rare but carries substantial clinical and ethical implications in symptom-directed venous interventions. This case illustrates the importance of a cautious, conservative-first, multidisciplinary approach to chronic pelvic pain, emphasizing careful symptom attribution in NCS-associated PCS. It also suggests that a staged treatment strategy, with reassessment of early stent stability and clinical response before considering embolisation of pelvic collateral pathways, may be considered in selected patients. Possible technical contributors include venous undersizing and limited landing zones; the role of altered flow after collateral embolisation remains speculative.