# Delayed Migration of an Amplatzer PFO Occluder to the Infrarenal Abdominal Aorta: Successful Endovascular Snare Retrieval

## TL;DR

A PFO occluder migrated to the abdominal aorta and was successfully removed using a minimally invasive endovascular snare technique.

## Contribution

Demonstrates successful endovascular retrieval of a delayed-migrated PFO occluder in a stable patient.

## Key findings

- Delayed migration of an Amplatzer PFO occluder to the infrarenal abdominal aorta was incidentally detected.
- Endovascular snare retrieval via the femoral artery successfully removed the device without complications.

## Abstract

Background and Clinical Significance: Embolization of septal occluder devices after patent foramen ovale (PFO) closure is uncommon but potentially serious, as migrated devices may lodge in the arterial system and require urgent management. Cross-sectional imaging may reveal delayed migration incidentally, and endovascular snare retrieval represents a minimally invasive first-line strategy in stable patients. Case Presentation: An 18-year-old woman presented with acute abdominal pain one month after percutaneous PFO closure performed for preventive purposes in the setting of migraine with visual aura. Contrast-enhanced computed tomography (CT), obtained for suspected intra-abdominal bleeding, demonstrated hemoperitoneum from a hemorrhagic ovarian cyst and incidentally identified the Amplatzer occluder lodged in the infrarenal abdominal aorta with preserved renal artery patency. Transthoracic echocardiography confirmed device absence at the interatrial septum. Endovascular retrieval was performed via right common femoral artery access (5 Fr upsized to 12 Fr) using a 20 mm snare system, with successful removal of the device through the introducer and no intra-procedural complications. Conclusions: Delayed migration of a PFO occluder can be detected incidentally during evaluation for unrelated symptoms. In hemodynamically stable patients, transfemoral endovascular snare capture and re-sheathing through a large-bore introducer can achieve safe and effective device retrieval while preserving aorto-iliac patency.