The Secret Life of a Lost Guidewire.

BACKGROUND

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

CASE SUMMARY: 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.

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

TAKE-HOME MESSAGES: 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.