Discussion
A fracture and retention of guide-wires are uncommon but a known
complication of the interventional cardiology procedures. Most cases are
diagnosed immediately or just after the procedures and the wires are
retrieved either percutaneously or surgically [3]. Rarely, the
fractured wire may be missed inadvertently at the time of procedure and
diagnosed late when the patient had complications related to the
retained foreign body [4], or incidentally diagnosed while
diagnostic evaluation for the other diseases.
Our patient had undergone two procedures; first, for implantation of
cardiac resynchronization therapy defibrillator (CRT-D) 3 years back,
and second, for replacement of left ventricular and right atrial lead
for lead dysfunction 6 months ago. Both the procedures were done at
different centres. Our patient had presented with pain in left arm and
shoulder due to migration of guide-wire from CRT-D pocket to left upper
arm, which became severe when the tip of the wire reaches to
subcutaneous tissue after crossing the deltoid muscle of the left arm.
Probably, the wire was fractured at the time of previous procedure and
was inadvertently missed at that time and retained in the pectoral
muscles and gradually migrated over time to arm with the movement of the
arm. Management of retained guide-wire is the retrieval of the wire
using either a percutaneous technique or open surgical technique
[5]. In our patient as the wire was impacted in arm muscles, and was
not suitable for percutaneous retrieval and thus open surgical retrieval
was done.