Guidewire Entrapment in the Chiari Network: A Serious Complication during Central Venous Port Insertion.

Abstract

This study reports a case of a J-shaped guidewire entrapped in a Chiari network during central venous port insertion. A female patient in her 50s with breast cancer was referred for a single-lumen port placement. The subclavian vein was accessed using an 18 G needle under ultrasound guidance, and a 0.035-inch J-shaped guidewire was passed to the superior vena cava under fluoroscopy. Resistance was encountered in the right atrium when advancing to the inferior vena cava, and the J-shaped guidewire was difficult to retract. The 4F catheter on the J-shaped guidewire was towed, and the J-shaped guidewire was removed despite strong resistance. The removed catheter was significantly deformed, and the J-shaped guidewire tip was entangled in a white, hard tissue, likely a Chiari network. The patient was asymptomatic intra- and postoperatively.