Current literature reports high symptomatic improvement rates of 70-85% for percutaneous vein embolization, whereas pharmacotherapy has had poor success in achieving pain relief. Surgical ligation is another effective treatment but is much more invasive.Complications of pelvic embolization include vein perforation and coil migration (either immediate or delayed) causing cardiac damage, arrhythmias, pulmonary infarct, and thrombophlebitis, with rates ranging from 4-8%. Few cases have been reported regarding migration of pelvic coils to the pulmonary vasculature, and rarely with symptomatic patients requiring endovascular retrieval of the coils.Pulmonary angiography demonstrating a migrated pelvic coil in the right pulmonary artery with guide wire and snare in place for retrieval. migration of nine internal iliac vein coils to the pulmonary artery, but the coils were not removed as the patient was asymptomatic. They, along with other studies, postulated that coils should be at least 30-50% the diameter of the target vessel in order to decrease migration risk. They also describe using coils with a stronger radial force, for example measuring 0.035 inch, as veins have lower frictional resistance (increased elasticity) between the vessel wall and the coils. Furthermore, larger vessels with a high-flow state (such as the internal iliac, as in our patient), are at higher risk for coil migration, especially when the varices are relieved and flow is increased. Tonkin, et al. described two cases of coil migration to the tricuspid valve and pulmonary arteries with a coil fragment in the right ventricle, which were asymptomatic and conservatively managed.None of these cases include removal of the coils nor the methods behind the retrieval process. Our patient developed pulmonary infarcts and a pleural effusion, which has not been previously reported, and thus necessitated urgent removal of the migrated coil, as we have described above. Although there were difficulties with VIR removal of the coil, this still prevented the patient from undergoing an open surgical procedure, which could lead to prolonged recovery time, longer hospital stay, and other post-operative complications such as non-healing wounds, infection, hemorrhage, pulmonary embolism, etc. Our patient had complete resolution of her symptoms and no additional complications on follow up.

With Best Regards,
Mark Williams
Journal Coordinator
Jounral of Vascular and Endovascular Therapy