A modified two-step technique for the retrieval of a chemoport catheter fragment with inaccesible ends

BACKGROUND: Migration of central venous catheters is a rare but serious complication. The endovascular approach has been widely used for the retrieval of such fragment, with the two-step technique used for removal of catheter fragments with inaccessible ends. In this case report, we describe a modification of this technique that was used after first attempting the two-step technique unsuccessfully. CASE PRESENTATION: A 42-year-old female with breast cancer had a chemoport inserted for chemotherapy. After 6 cycles of chemotherapy the port could not be flushed and a chest radiograph demonstrated a migrated catheter fragment. CT scan demonstrated that one end of the fragment was in the liver in the middle hepatic vein and the other in the right atrial appendage. A modified 2 step technique, using a pigtail catheter, hydrophilic wire and snare was used to remove this fragment. CONCLUSION: In this case report we highlight a new modification of the 2-step technique that can be employed when the conventional 2 step technique does not work.