Endovascular Removal of a migrated PICC line electrode fragment in the right ventricle: percutaneous management of a rare complication

Background
Peripherally inserted central catheters (PICCs) are commonly used for long-term intravenous therapies, particularly in oncology patients receiving chemotherapy. Although generally safe, rare but serious complications can occur, including catheter fracture with intravascular migration of fragments. Embolized fragments may lodge in the right heart chambers, pulmonary arteries, or other vessels, potentially causing arrhythmias, cardiac perforation, thrombosis, infection, or pulmonary embolism. Early detection via imaging is critical, as many cases remain initially asymptomatic. Percutaneous endovascular retrieval using snare devices is now the preferred minimally invasive approach, offering high success rates with low morbidity compared to surgical intervention. This case emphasizes the importance of post-removal radiographic surveillance and advanced imaging in managing this uncommon complication.
Methodology
A 65-year-old woman underwent left hemicolectomy for stage III descending colon adenocarcinoma, followed by adjuvant FOLFOX chemotherapy administered through a right-arm PICC. The treatment course was uneventful, and the PICC was removed in an outpatient setting without apparent issues. During a routine chest radiograph, a linear radiopaque foreign body was incidentally noted over the cardiac silhouette. Contrast-enhanced thoracic computed tomography (CT) confirmed a linear, high-attenuation fragment within the right ventricle. No pericardial effusion, intracardiac thrombosis, myocardial perforation, or other complications were detected. The patient remained asymptomatic.
Results
Elective percutaneous endovascular retrieval was performed due to potential delayed complications. Under fluoroscopic guidance, access was obtained via the right common femoral vein. A loop snare device was advanced into the right ventricle, where the migrated PICC fragment was successfully captured and removed intact without arrhythmia, vessel injury, or fragment dislodgement. Post-procedure imaging confirmed complete removal with no residual fragments or new abnormalities. The patient was discharged the following day in stable condition.
Conclusion
PICC fracture with intracardiac migration is a rare but potentially dangerous complication, influenced by prolonged use, mechanical stress, and improper handling. Advanced imaging, particularly contrast-enhanced CT, is essential for accurate localization, exclusion of associated pathology, and procedural planning. Percutaneous snare retrieval via femoral access proved safe and effective, highlighting its role as first-line therapy for embolized catheter fragments. Routine post-removal radiographs, proper staff training, and a multidisciplinary approach involving interventional radiology are recommended to enhance patient safety and prevent severe outcomes in oncology settings.