Nonsurgical transvenous retrieval of fractured implantable central venous access device

Implantable central venous access devices (ICVADs) are commonly used in patients with cancer and chronic diseases. Fracture and distal embolization of an ICVAD fracture is rare. A total of 1,006 central venous access procedures using ICVADs were done in National Taiwan University Hospital from January 1994 to December 1996. ICVAD fractures were noted in five of these 1,006 cases. All the fractured catheters were retrieved successfully by nonsurgical transvenous methods. The clinical manifestations were nonspecific palpitation or chest pain. The fracture site was always on the crossover point of the clavicle and the first rib on chest radiography. A pinch-off mechanism was suspected, and supported by scanning microscopy imaging. A deformed and elliptical shape of the fractured catheter site resulted from repeated wear and tear by the movement of the clavicle and first rib and associated muscle groups. The clinical course was benign if early retrieval of the distal fractured catheter by snare loop was possible. A more lateral position by a subclavian approach or an axillary approach for central venous access may avoid this procedure-related complication.