Abstract:
Background: Lost guidewires during central venous catheterization are rare but serious, requiring prompt removal to reduce morbidity and mortality.
Case summary: A 58-year-old woman presented with a pulsating back mass and a spontaneous bruise under her left clavicle. More than 10 years ago, a 0.035-inch guidewire had been lost in her circulation, and retrieval attempts had failed. Computed tomography scan revealed a fragmented guidewire that had crossed into the arterial circulation through a patent foramen ovale and extended through the anterior mediastinum. After a discussion among the heart team, the decision was made to remove the wire percutaneously.
Discussion: This case highlights the risks of guidewire loss and the successful use of advanced catheter techniques for complex wire retrieval.
Take-home messages: Iatrogenic guidewire loss is associated with significant risk of morbidity and mortality, and the guidewire must be removed. A fragmented wire can be removed percutaneously by forming a free loop with an additional wire. If wire embolization is recognized during central venous catheter insertion, several bedside techniques can be attempted to rapidly correct the complication.
Reference:McGrath S, Bagnall T, Pegge N, Hildick-Smith D. The Secret Life of a Lost Guidewire. JACC Case Rep. 2025 Jul 23;30(20):104181. doi: 10.1016/j.jaccas.2025.104181. PMID: 40713126.