Accidental migration of ASH-split catheter during central venous catheter replacement: retrieval using an...

Catheter fracture and embolization of the distal fragment are well-known complications of subclavian central venous long-term cannulation. In hemodialysis it is an exceptional event. We report a case of accidental rupture of a cuffed hemodialysis catheter with distal migration of a fragment during a procedure of catheter exchange via guide-wire. According to most reported cases, intravascular catheter separation usually occurs completely asymptomatically; our report confirms that catheter embolization itself is usually asymptomatic. Less than one third of the literature-reported cases have associated symptoms, such as palpitations or chest discomfort. Once diagnosed, treatment is an interventional radiological approach, which has a very high success rate. The replacement of permanent cuffed hemodialysis catheters via guide-wire is a delicate procedure and if catheter embolization is diagnosed, the patient must be referred to a center with specific experience in the retrieval of intravascular objects.