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Intravascular Embolization of Venous Catheter—Causes, Clinical Signs, and Management: A Systematic Review

From the ¹ Department of Radiology,² Department of Biology, and³ Department of Cardiology and Intensive Care Medicine, Martin Luther University, Halle, Germany.

Address correspondence to: Alexey Surov, Department of Radiology, Martin-Luther-University Halle-Wittenberg, Ernst-Grube St. 40, 06120 Halle, Germany; e-mail: alex.surow{at}medizin.uni-halle.de.

Background: Intravascular embolization of device fragments is a rare but potentially serious complication. Method: A systematic search of the PubMed and MEDLINE databases for all articles pertaining to central catheter related embolization published in English between 1985 and 2007 was made. Results: A total of 215 cases of intravenous catheter embolization were identified. There were 143 totally implanted venous devices (TIVD) or port catheters and 72 percutaneous venous catheters (PVC). Sites of catheter fragments following embolization were the superior vena cava or peripheral veins (15.4%), the right atrium (27.6%), right ventricle (22%), and pulmonary arteries (35%). Clinical signs of catheter embolization included catheter malfunction (56.3%), arrhythmia (13%), pulmonary symptoms (4.7%), and septic syndromes (1.8%), but 24.2% of cases were asymptomatic. The causes of intravascular catheter embolization were pinch-off syndrome (40.9%), catheter injury during explantation (17.7%), catheter disconnection (10.7%), and catheter rupture (11.6%). In 19.1% of cases, the cause of catheter embolization could not be identified. Most embolized catheter fragments (93.5%) were removed percutaneously. In 4.2% of cases, fragments were retained in the vascular bed; in 2.3%, embolized fragments were removed surgically via thoracotomy. Conclusion: Intravascular catheter embolization can go undiagnosed for prolonged periods. Patients might be asymptomatic or may develop severe systemic clinical signs. The mortality rate is 1.8%. There were no significant differences in clinical features of embolization between TIVD and PVC groups.

Key Words: venous catheter • intravascular embolization • pinch-off syndrome • venous access • internal medicine

This version was published on November 1, 2009

Journal of Parenteral and Enteral Nutrition, Vol. 33, No. 6, 677-685 (2009)
DOI: 10.1177/0148607109335121


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