Retained Guidewire Following Bedside Femoral Venous Catheterization: A Case Report

Retained guidewire after central venous catheterization (CVC) placement is a rare but preventable complication. Despite advances in ultrasound-guided catheterization and procedural safety, guidewire retention continues to be reported and may result in vascular injury, thrombosis, embolization, arrhythmia, or infection. We report the case of a 62-year-old male who underwent ascending aorta and total arch replacement for acute type I aortic dissection. On postoperative Day 11, a hemodialysis catheter was inserted into the right femoral vein under ultrasound guidance for continuous renal replacement therapy (CRRT). Sequential radiographs obtained within hours demonstrated cranial migration of a retained guidewire from the inferior vena cava (IVC) to the internal jugular vein (IJV); however, the finding was initially misinterpreted as an imaging artifact. The guidewire was recognized ~24 h after insertion and successfully retrieved percutaneously in the angiography suite using a 6-Fr loop snare under fluoroscopic guidance. Completion venography confirmed intact removal without vascular injury or immediate complication. Although the patient later developed an aorto-esophageal fistula and died of septic shock on postoperative Day 86, there was no clinical or radiologic evidence linking the retained guidewire or its retrieval to the cause of death. This case highlights the potential for rapid intravascular migration, the risk of radiographic misinterpretation, and the necessity of structured "wire-out" verification before flushing or securing CVCs, even when ultrasound guidance is used.