Lost to Follow-Up After Patent Foramen Ovale (PFO) Closure: Late Detection of Abdominal Aortic Embolization of an Occluder Device

Embolization of a patent foramen ovale (PFO) occluder is a rare complication, particularly when detected years after device implantation. We report a case of a 30-year-old patient who initially presented with acute right lower limb ischemia caused by embolic occlusion of multiple arteries. A floating thrombus was detected in the inferior vena cava, and subsequent evaluation revealed a PFO, a bicuspid aortic valve, and an aortic arch anomaly. Six weeks later, PFO closure was performed using a 25 mm Amplatzer Cribriform device (Abbott, Chicago, Illinois), followed by appropriate post-procedural antithrombotic therapy. Nearly five years after implantation, routine follow-up revealed asymptomatic embolization of the occluder to the suprarenal abdominal aorta at the level of the superior mesenteric artery, without evidence of limb or renal hypoperfusion; the exact timing of embolization could not be determined. Percutaneous retrieval was attempted but aborted due to pain and the high risk of aortic injury, and the device was therefore left in situ. This case highlights a rare late complication of PFO closure and underscores the importance of long-term surveillance in patients with complex cardiovascular anatomy and thrombotic risk factors.