Vascular Health and Risk Management (Jun 2024)
A Double Rarity: Lost intravascular Catheter Guidewire in Persistent Left Superior Vena Cava and Coronary Sinus - A Case Report
Abstract
Benjamin Palić,1,2 Marija Goluža Sesar,3 Kristina Galić,3 Gojko Bogdan,4 Zrinko Prskalo1 1Department of Internal Medicine, University Clinical Hospital Mostar, Mostar, Bosnia and Herzegovina; 2Department of Pathophysiology, School of Medicine, University of Mostar, Mostar, Bosnia and Herzegovina; 3Department of Pulmonology, University Clinical Hospital Mostar, Mostar, Bosnia and Herzegovina; 4Department of Radiology, University Clinical Hospital Mostar, Mostar, Bosnia and HerzegovinaCorrespondence: Benjamin Palić, Department of Internal Medicine, University Clinical Hospital Mostar, Mostar, Bosnia and Herzegovina, Email [email protected]: Guidewire loss is a rare complication of central venous catheterization. A 65-year-old male was hospitalized in a high-dependency unit for exacerbation of chronic obstructive pulmonary disease, pneumonia, erythrocytosis, and clinical signs of heart failure. Upon admission, after an unsuccessful right jugular approach, a left jugular central venous catheter was placed. The next day, chest radiography revealed the catheter located in the left parasternal region, with suspected retention of the guidewire, visually confirmed by the presence of its proximal end inside the catheter. The left parasternal location of the catheter and the typical projection of the guidewire in the coronary sinus, later confirmed by echocardiography, raised suspicion of a persistent left superior vena cava (PLSVC). Agitated saline injected into the left antecubital vein confirmed bubble entry from the coronary sinus into the right atrium. After clamping the guidewire, the catheter was carefully retrieved along with the guidewire without any complications. This is the first reported case of guidewire retention in PLSVC and coronary sinus. It underscores the potential causes of guidewire loss and advocates preventive measures to avoid this potentially fatal complication.Keywords: intraoperative complication, central venous catheter, persistent left superior vena cava, congestive heart failure, chronic obstructive lung disease
