# Pinch-off syndrome leading to catheter fracture: a rare complication of central venous port systems, a case report

## TL;DR

A rare case shows a central venous catheter migrated to the pulmonary artery but caused no complications for six years.

## Contribution

This case report highlights that asymptomatic catheter migration may not require removal.

## Key findings

- A patient's catheter migrated to the pulmonary artery but remained complication-free for 6 years.
- Asymptomatic catheter migration may not necessitate removal, challenging standard removal protocols.
- Pinch-off syndrome can lead to catheter dysfunction, fracture, or migration.

## Abstract

Totally implantable venous access devices provide long-term venous access for patients requiring extended therapies, such as chemotherapy, with lower risks of infection and extravasation. These devices are typically placed in the subclavian or internal jugular vein and connected to a subcutaneous port. Following implantation, a chest X-ray is used to confirm catheter placement, detect early complications, and identify the “pinch-off sign”—a warning of potential catheter compression between the clavicle and first rib. Complications include malposition, pneumothorax, infection and catheter dysfunction such as pinch-off syndrome (POS), catheter fracture, and migration. POS can cause catheter dysfunction, fracture, and migration, potentially leading to severe cardiovascular or neurological complications, including cardiac perforation and pulmonary embolism. In some cases, catheter migration is asymptomatic and discovered incidentally. When catheter fragments migrate, removal via a percutaneous transvenous approach is preferred to avoid complications. However, in asymptomatic patients, observation may be a suitable alternative if the fragment adheres to the vessel. We report the case of a 25-year-old patient under surveillance for metastatic medullary thyroid carcinoma, whose catheter migrated to the pulmonary artery and remained complication-free for 6 years. This case highlights the importance of routinely checking for pinch-off syndrome whenever a central catheter is placed, and it suggests that removal of migrated catheter fragments may not be necessary in asymptomatic patients.