Right-atrial retrieval of a fractured central venous catheter using the pigtail-through-snare technique under biplane fluoroscopy: A case report

Fracture and migration of central venous catheter fragments can precipitate arrhythmia and other complications, and timely endovascular retrieval is recommended. A 52-year-old woman experienced catheter transection at the port-catheter junction during attempted port removal. Initial imaging showed no intracardiac migration. Four days later, a frontal chest radiograph demonstrated a fragment in the right atrium, and electrocardiogram monitoring revealed frequent premature contractions. Using the pigtail-through-snare maneuver under biplane fluoroscopy, a snare loop was opened in the RA, and a pigtail catheter passed through the loop hooked the mid-portion of the fragment. A controlled sweep redirected the RV-side proximal end into the snare without advancing the pigtail into the right ventricle, enabling secure capture and withdrawal via femoral access. Premature contractions resolved immediately, and no complications occurred; cumulative air kerma and dose-area product were 200.5 mGy and 40.17 Gy·cm², respectively. Biplane-guided pigtail-through-snare retrieval facilitates orthogonal, real-time alignment and can reduce blind sweeping, offering a reproducible option when no free end is accessible.