Abstract
BACKGROUND: Migration of gonadal vein embolization coils into the heart is rare but can lead to serious complications such as thrombosis, infection, or perforation. CASE SUMMARY: A 27-year-old woman presented with chest pain 2 years after bilateral gonadal vein embolization. Imaging revealed a migrated coil adherent to the right atrium. Initial femoral snaring attempts caused coil fragmentation. Successful retrieval was achieved using a combined balloon-assisted trapping technique and AngioVac aspiration via femoral and internal jugular access. The patient recovered uneventfully without residual fragments or complications. DISCUSSION: Endothelialization of migrated coils can impede percutaneous retrieval and increase procedural complexity. Multimodal strategies integrating aspiration and mechanical trapping may enhance success and avoid surgery. TAKE-HOME MESSAGES: Migrated embolization coils can be safely retrieved percutaneously using advanced multimodal techniques. Preprocedural imaging, multidisciplinary planning, and access to specialized equipment are essential for successful and complication-free outcomes.