The Secret Life of a Lost Guidewire

Lost guidewires during central venous catheterization are rare but serious, requiring prompt removal to reduce morbidity and mortality.

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.

This case highlights the risks of guidewire loss and the successful use of advanced catheter techniques for complex wire retrieval.

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.