Percutaneous Retrieval of a Hepatic Vein Stent From the Right Ventricle: The triPle-rAil snare Technique.

OBJECTIVE: We describe the Triple-Rail Snare Technique, a novel endovascular rescue strategy for percutaneous retrieval of a large self-expanding nitinol stent that migrated from the hepatic vein to the right ventricle (RV) following treatment of posthepatectomy Budd-Chiari syndrome. KEY STEPS: Large-bore (22-F) femoral venous access with planned preclosure using 2 suture-mediated devices before sheath insertion. Three-loop snare capture of the stent within the RV; smooth retraction through the tricuspid valve into the inferior vena cava (IVC). Following failed standard resnaring in the IVC: Triple-Rail scaffold constructed using 1 intraluminal 0.035-inch Amplatz Super-Stiff wire and 2 extraluminal 0.035-inch J-tip starter wires. Single-loop GooseNeck snare advanced over the 3-wire scaffold; definitive capture at the distal stent struts; complete retrieval through the 22 F sheath. POTENTIAL PITFALLS: Stent fragmentation during IVC manipulation; tricuspid leaflet entrapment or RV perforation during initial cardiac retrieval; femoral access site hemorrhage if large-bore preclosure is not planned prospectively. TAKE-HOME MESSAGES: When standard snaring fails for large self-expanding stents in the IVC, the Triple-Rail Snare Technique restores reliable snare capture using only standard catheterization laboratory inventory. Planned large-bore venous preclosure is mandatory for stents of this caliber.