The Dancing Fractured-Permcath: Comprehensive Diagnostic Assessment of Etiology and Novel Balloon-Stabilized Endovascular Retrieval Technique

Fracture and embolization of tunneled hemodialysis catheters are rare but potentially life-threatening, particularly when fragments migrate to the right atrium (RA), inferior vena cava (IVC), and pulmonary arteries. A middle-aged female on maintenance hemodialysis presented after attempted permacath removal, resulting in a fractured 14.5 Fr permacath fragment (approximate length 11 cm) oscillating between the RA and IVC. Severe tricuspid regurgitation (TR) contributed to the fragment's vigorous motion, which was retrospectively diagnosed on two-dimensional echocardiogram. Endovascular retrieval was performed via the right great saphenous vein access, using balloon-assisted stabilization at the IVC–RA junction, gooseneck snaring, and wire-through-fragment access preservation. This strategy allowed safe fragment removal and immediate replacement with a new hemodialysis catheter, providing hemostasis and dialysis access completely avoiding surgical intervention. Balloon-stabilized endovascular retrieval preferentially via superficial venous access is a safe, minimally invasive option for large, mobile catheter fragments, particularly in patients with severe TR, enabling preservation of dialysis access without need for surgery.