**Background:** Totally implantable venous access devices (port catheters) are widely used for long-term drug administration, particularly in oncology patients requiring chemotherapy. While generally safe, these devices can develop complications including catheter occlusion, thrombosis, infection, and rarely, catheter fracture and embolization. Pinch-off syndrome occurs when a central catheter inserted via the subclavian approach becomes compressed between the clavicle, first rib, subclavius muscle, and costoclavicular ligament, leading to fracture. Embolization of fractured catheter fragments to the pulmonary artery is extremely rare. When catheter fragments embolize, they typically lodge in the right ventricle and cause arrhythmias, and standard management involves percutaneous removal via interventional radiology. Surgical removal is reserved for cases where interventional approaches fail. The authors present a unique case of a patient managed non-operatively for 15 years after catheter fracture and pulmonary artery embolization.
**Methods:** This is a single case report from a clinic in Türkiye. The patient's medical history was reviewed retrospectively, including surgical records, imaging studies, and clinical follow-up from 1998 through 2019. Imaging included chest X-ray, computed tomography (CT), and positron emission tomography-CT (PET-CT).
**Key Results:** The patient was a 53-year-old female initially diagnosed with Stage IIIC ovarian cancer in June 1998. She underwent debulking surgery followed by six cycles of adjuvant carboplatin and paclitaxel. Over the next 16 years, she experienced multiple recurrences requiring reoperations in 2000, 2001, 2002, 2006, 2009, 2010, 2012, 2013, and July 2014. A port catheter was first inserted into the right subclavian vein in 2002 at Johns Hopkins Hospital and was removed in 2005 due to blockage. At that time, a portion of the catheter fractured and remained in the superior vena cava. The patient was started on warfarin. During follow-up imaging, the catheter fragment migrated from the superior vena cava to the right pulmonary artery. Due to the patient's recurrent cancer, no surgical intervention was planned. Warfarin was continued until 2017 (12 years). A second port catheter was inserted through the right subclavian vein in 2017 but was removed in February 2019 due to infection. In June 2019, the patient presented urgently with abdominal pain and vomiting and was diagnosed with an ileoileal fistula, which was managed medically. PET-CT revealed multiple lung metastases and pleural effusion, with adenocarcinoma cells (consistent with ovarian metastasis) detected in pleural fluid cytology. Imaging showed the distal catheter tip in the middle lobe branch of the right pulmonary artery. The patient refused catheter removal. A new port was inserted through the left subclavian vein. Remarkably, the patient remained free of complications from the embolized catheter for 15 years after the initial fracture (12 years on warfarin, 3 years off warfarin). The catheter had fractured into three parts: the proximal part was removed, the middle part remained between the subclavian vein and skin, and the long distal part was embolized to the pulmonary artery.
**Clinical Implications:** This case demonstrates that non-operative management of catheter fragments embolized to the pulmonary artery may be feasible in select patients, particularly those with limited life expectancy due to advanced malignancy or those who refuse intervention. The authors hypothesize that epithelialization of the catheter may have prevented complications. However, this approach contradicts standard recommendations, as the risk of pulmonary embolism is generally considered high, and percutaneous removal is the preferred management. This is the first reported case of such long-term asymptomatic follow-up without catheter removal, and it should not be considered standard practice but rather an observation in a unique clinical circumstance.