CathLabHub

CathLabHub complications toolkitcathlabhub.com/toolkit/device-embolizationIn review, October 24, 2026

Recognize

The signs on the monitor, the image and the patient.

  • ImageThe device is no longer at its site on fluoroscopy or echo; it may lie in the atrium, the ventricle, the aorta or a peripheral artery 1.
  • MonitorVentricular ectopy or VT when it lies in the ventricle; hypotension with outflow or valve obstruction.
  • EchoNew valve regurgitation or obstruction, or the device moving in a chamber.
  • PatientSigns of ischemia in a limb or organ when it lodges distally.

Act now

In the order the operator does them. The first three come first, whatever else is happening.

  1. Track the device with fluoroscopy and echo; do not lose sight of it.
  2. Call for help: a second operator experienced in snaring, the surgeon and anesthesia 1.
  3. Stabilize: rhythm and pressure; anticoagulation stays on.
  4. Retrieve with a snare through a long sheath: 12 to 16 Fr Mullins type sheaths for occluders, 10 Fr or more to recapture an occluder 1.
  5. Snare any part of the frame and pull it into the sheath; if it will not enter, remove the snare, device and sheath together 1.
  6. Do not attempt snaring without experience; surgery is the alternative 1.
  7. A device in the left ventricle or across a valve often needs surgery.

Equipment

From the complications cart. Linked items open in the equipment directory.

Drugs

Adult doses as the cited source gives them. Check your formulary and the label.

Who to call

The escalation ladder, first call first.

  1. Second structural operator: with snaring experience 1.
  2. Cardiac surgery: at the event.
  3. Echo (TEE or ICE): to guide capture.
  4. Anesthesia: general anesthesia for retrieval.

The bailout step by step

Snare retrieval through a long sheath 1

  1. Place a large long sheath close to the device (12 to 16 Fr for occluders) 1.
  2. Pass a snare through it and loop any part of the frame or the hub; a hub capture lets the device collapse best.
  3. Close the snare and pull the device to the sheath tip.
  4. Advance the sheath over the device as you pull; collapse it inside.
  5. If it will not enter, withdraw snare, device and sheath as one unit to the femoral vein or artery and remove there, by cutdown if needed 1.
  6. Image the heart and the vessels for injury afterward.

Prevent

  • Accurate sizing with TEE, ICE or CT; the release criteria for each device before release 4.
  • A tug test and a final check of position before release.
  • Keep snares and large sheaths in the room for every structural case 1.

After care and documentation

  • Echo for valve damage and effusion; vascular check at the retrieval access.
  • Document the device, where it embolized and how it was retrieved; report through your device reporting process and the registry.
  • Plan the next step: a different device, a larger size or surgery.

Practice

No emergency simulator case for device embolization yet; the structural simulator in the app includes the LAAO and closure devices. Browse the case library.

References

  1. Transcatheter closure of atrial septal defects and patent foramen ovale. In: Kern MJ, ed. The Interventional Cardiac Catheterization Handbook. 3rd ed. Saunders, Elsevier; 2013. Chapter 20.
  2. Brilakis ES. Manual of Percutaneous Coronary Interventions: A Step-by-Step Approach. Academic Press, Elsevier; 2021. Chapter 3, Medications.
  3. Panchal AR, Bartos JA, Cabanas JG, et al. Part 3: adult basic and advanced life support. 2020 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation 2020;142(suppl 2):S366-S468.
  4. Saw J, Holmes DR, Cavalcante JL, et al. SCAI/HRS expert consensus statement on transcatheter left atrial appendage closure. JSCAI 2023;2:100577.

Educational reference for cath lab teams, not medical advice and not a standard of care. Your local policy, the device instructions for use and current guidelines govern. Verify every dose before use. Printed from cathlabhub.com/toolkit/device-embolization. First version, in clinical review: an interventional cardiologist is checking every card before it is final. Every number cites its source on the card.