Acute limb ischaemia due to paradoxical embolism from a long-term central venous catheter

Introduction all pulses in the right leg were easdy palpable. A source of arterial embolism was not clinically evident The use of indwelling central venous catheters for Emergency angiography showed an occlusion of the long-term access for therapeutic regimens is becoming mid-left common iliac artery extending to the mid increasingly common, and the complications asexternal iliac artery. The right common, external and sociated with these hnes are well recognised. Cominternal iliac arteries and the left femoral, popliteal plications associated with insertion include and proximal trifurcation arteries were reported as pneumothorax, haemothorax, inadvertent arterial entirely normal. The appearance strongly suggested puncture, cardiac tamponade, and catheter emarterial embolism. Thrombolysis was inappropriate, bolisation. Long-term problems encompass sepsis and as the left leg had developed a neurosensory deficit. venous thrombosis. Paradoxical embolism has not preThe left groin was explored under local anaesthesia viously been described originating from a central venand an embolectomy was attempted. Adequate inflow ous line. We report a case of acute lower limb ischaemia could not be established, and this was felt to be due occurrmg as a result of paradoxical ebolisation of to organisation of previous emboli. A femorofemoral thrombus arising from an indwelling central venous crossover graft was performed using a polytetracatheter, fluoroethylene graft which successfully revascularised the left leg. Abdominal ultrasonography and transthoracic echoCase Report cardiography both failed to identify an embolic source. Subsequent transoesophageal echocardiography re-