Silent Retention: Endovascular Retrieval of a Guidewire Undetected for Three Months in an ESRD Patient: A Case Report

Central venous catheterization (CVC) is a common procedure in clinical practice, yet retained guidewires represent a rare but potentially life-threatening complication. Although most cases are recognized earlier, delayed detection in asymptomatic patients, especially those on hemodialysis, is rare and requires safe management protocols. A 45-year-old female with a 13-year history of uncontrolled hypertension and end-stage renal disease (ESRD) on long-term hemodialysis was referred to the cardiology department following an incidental finding of a retained guidewire on a posterior-anterior (PA) chest X-ray. The guidewire had been inadvertently left in situ during the placement of a permanent venous catheter in the right internal jugular vein at an outside hospital three months earlier. The lack of post-catheterization imaging resulted in delayed recognition of the guidewire. Despite its prolonged retention, the patient remained asymptomatic and continued her routine hemodialysis sessions without access-related complications. Imaging revealed a 50 cm J-tip guidewire extending from the internal iliac vein to the right internal jugular vein. After obtaining informed consent, the guidewire was successfully retrieved using an endovascular approach in the interventional radiology suite. Post-procedural imaging confirmed complete removal, and the patient was discharged in stable condition with no complications at follow-up. This case highlights the importance of procedural vigilance, adherence to standardized protocols, and early intervention to mitigate the risks associated with retained intravascular foreign bodies.