Stepwise dual-access endovascular retrieval of a fractured PICC embolized to the pulmonary arteries: A case report

Peripherally inserted central catheters (PICCs) are commonly used for prolonged intravenous therapies, particularly in oncology patients requiring chemotherapy. Although generally safe, PICC-related complications such as catheter fracture and embolization are rare but potentially life-threatening conditions requiring urgent intervention. We report a rare case of PICC line fracture with embolization into the bilateral pulmonary arteries in a 57-year-old female undergoing chemotherapy for esophageal carcinoma at a private hospital in Dar es Salaam, Tanzania. The patient was asymptomatic, and chest computed tomography demonstrated a fractured PICC line looped within the right and left pulmonary arteries. Endovascular retrieval was initially attempted through a femoral venous approach using balloon-assisted mobilization and snare techniques; however, both strategies failed because the catheter lacked an accessible free end. Following A stepwise dual-access approach was subsequently performed using pigtail catheter-assisted repositioning of the fragment into the inferior vena cava followed by successful snare retrieval through the right internal jugular vein. The catheter was retrieved intact without procedural or cardiopulmonary complications. The patient was monitored for 24 hours postprocedure and subsequently discharged, with continued oncology admission for advanced metastatic disease unrelated to the PICC complication. This case demonstrates the feasibility of stepwise dual-access endovascular techniques for retrieval of complex embolized PICC fragments from the pulmonary circulation, particularly in resource-constrained settings.