A Systematic Review of Intracardiac Embolization of Central Venous Catheter Fragment—Unraveling Pandora’s Box

Abstract

A systematic review was conducted to investigate the relationship between the duration of intracardiac central venous catheter (CVC) fragment embolization and its manifestations and interventions. We searched the MEDLINE, Embase, Google Scholar, and Scopus databases over a 4-decade period. The collected data included CVC type, duration from implantation to identification of embolization, symptomatology, embolization sites, interventional approaches, and outcomes. Out of 295 cases, 62.4% of embolizations occurred within the first year, with 13% occurring in the pulmonary artery only. Based on clinical manifestations, the duration in CVC malfunctioning group was the shortest (median 37.5 weeks, interquartile Range [IQR] 13-53.2, P < 0.05 vs asymptomatic and symptomatic groups). In terms of interventions, the percutaneous retrieval group had the shortest duration (median 34.8 weeks, P < .05 vs surgical retrieval or non-retrieval groups). A logistic regression analysis indicated that a shorter duration predicted a higher success rate of percutaneous retrieval (odds ratio = 1.007, 95% CI = 1.004-1.010, P < .0001), while being symptomatic forecasted a higher probability of non-percutaneous retrieval (odds ratio = 0.195, 95% CI = 0.063-0.610, P = 0.0448). We suggest that earlier identification of fragmented catheters, especially in malfunctioning CVC, increases the success rate of percutaneous retrieval.