Paradoxical Embolization of an Intravenous Catheter Fragment through Patent Foramen Ovale: A Rare Case of Acute Limb Ischaemia

Kübra Gözacık Karakoç

Abstract

Background: Paradoxical embolism occurs when venous materials traverse through a patent foramen ovale (PFO) into arterial circulation. Catheter fragment embolisation represents an unusual cause of arterial occlusion with significant morbidity.
Case Presentation: An 83-year-old female presented with sudden-onset pain, coldness, and cyanosis of the right lower extremity 15 days after pacemaker implantation requiring intravenous catheterisation. Physical examination revealed absent popliteal and distal pulses. Vascular imaging confirmed acute arterial occlusion. During surgical embolectomy, a 20G pink-coloured intravenous catheter fragment (32 mm) was unexpectedly retrieved. Postoperative echocardiography identified a PFO. The patient improved with antithrombotic therapy following revascularisation.
Conclusion: This case demonstrates paradoxical embolisation of catheter fragments through a PFO following intravenous catheterisation. Venous-to-arterial paradoxical embolisation should be considered in unexpected arterial occlusions. Meticulous monitoring of catheter integrity and systemic PFO evaluation are critical in preventing these rare but potentially life-threatening complications.