Left lower extremity venogram and common iliac venoplasty: guidewire-induced arrhythmia.

INTRODUCTION AND IMPORTANCE

Modern interventional procedures utilizing guidewires for venous and arterial access, while generally safe, can occasionally lead to complications that challenge the skills of anesthesia providers.

CASE PRESENTATION

We describe a case in which an angioplasty guidewire migrated from the left common iliac vein into the main pulmonary artery, resulting in premature ventricular contractions (PVCs). During the procedure, intraoperative electrocardiogram (ECG) monitoring detected multiple PVCs that persisted without spontaneous resolution. Fluoroscopy subsequently revealed the guidewire's migration into the pulmonary artery.

CLINICAL DISCUSSION

The wire was successfully withdrawn under live imaging, which resolved the PVCs without further complications. Guidewire misplacement in venous access procedures is uncommon but can cause mechanical irritation to cardiac tissue, leading to arrhythmias such as PVCs. In this case, timely recognition and intervention prevented further escalation of the arrhythmia.

CONCLUSION

This case underscores the potential for guidewire migration to cause significant intraoperative complications, such as arrhythmias, and emphasizes the importance of vigilant ECG and hemodynamic monitoring during procedures involving guidewires, even those performed on the lower extremities.