title: Intravascular embolization of venous catheter--causes, clinical signs, and management: a systematic review.
abstract: BACKGROUND
  Intravascular embolization of device fragments is a rare but potentially serious complication.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Radiology, Martin Luther University, Halle, Germany. alex.surow@medizin.uni-halle.de
authors.forename: Alexey
authors.initials: A
authors.lastname: Surov
authors.forename: Andreas
authors.initials: A
authors.lastname: Wienke
authors.forename: Justin M
authors.initials: JM
authors.lastname: Carter
authors.forename: Dietrich
authors.initials: D
authors.lastname: Stoevesandt
authors.forename: Curd
authors.initials: C
authors.lastname: Behrmann
authors.forename: Rolf-Peter
authors.initials: RP
authors.lastname: Spielmann
authors.forename: Karl
authors.initials: K
authors.lastname: Werdan
authors.forename: Michael
authors.initials: M
authors.lastname: Buerke
mesh_terms: D001808:Blood Vessels; D002404:Catheterization / Q000009:adverse effects* / Q000295:instrumentation; D002405:Catheterization, Central Venous / Q000009:adverse effects* / Q000295:instrumentation; D002408:Catheters, Indwelling / Q000009:adverse effects*; D020878:Device Removal; D004617:Embolism / Q000209:etiology*; D004868:Equipment Failure; D005547:Foreign Bodies / Q000209:etiology / Q000628:therapy*; D005548:Foreign-Body Migration; D006801:Humans