Unusual clinical course, Mistake in diagnosis, Diagnostic / therapeutic accidents, Unusual setting of medical care, Educational Purpose (only if useful for a systematic review or synthesis)
Nidal Arnous, Souvonik Adhya, Biwar Marof
(Department of Medicine, University of Maryland Prince George’s Hospital Center, Cheverly, MD, USA)
Am J Case Rep 2019; 20:1427-1433
Retained guidewire is a recognized complication of intravascular interventions. The majority of cases are identified immediately or shortly after the procedure. In rare cases, the guidewire is identified incidentally by X-ray after the procedure. This report presents a rare case of a retained venous guidewire that was discovered two years after central venous catheterization.
CASE REPORT: A 52-year-old African-American man presented with a wire that was emerging from the skin near his right knee. He had undergone a right femoral central venous catheter placement two years previously. Imaging showed that the end of the guidewire was sited at the left pulmonary artery, and was associated with two small broken fragments of wire. During surgery to remove the guidewire, it had become adherent to the pulmonary artery wall. Most of the guidewire was removed, but the portion adherent to the pulmonary artery wall was left in place.
CONCLUSIONS: It is very rare for a retained guidewire to be discovered when it protrudes through the skin, two years after central venous catheter placement, as the majority of cases are discovered by physical inspection or imaging following intravascular interventions. Skill and attention in the clinical setting are required to minimize such complications.
Keywords: central venous catheters, endovascular procedures, Foreign-Body Migration