Endovascular retrieval of a fractured femoral venous sheath using dual venous access: A case report and review of the literature

Femoral venous sheath fracture with intravascular retention is a rare but potentially serious complication of angiographic and structural heart procedures, with limited guidance on optimal management. A 70-year-old woman with a superior sinus venosus atrial septal defect and partial anomalous pulmonary venous connection underwent transcatheter defect repair following optimization of pulmonary arterial hypertension. During withdrawal of the left femoral venous sheath, fracture of the distal portion occurred, resulting in intravascular retention within the iliac–femoral venous system. Initial subcutaneous retrieval was unsuccessful. A structured endovascular bailout strategy using dual femoral venous access, wire escalation, and retrograde snare capture was performed. The fractured sheath fragment was successfully redirected and completely extracted without vascular injury or need for surgical intervention. The patient remained hemodynamically stable, and recovery was uneventful. Femoral venous sheath fracture can be safely managed using a structured percutaneous retrieval strategy incorporating dual venous access and controlled retrograde snare retrieval.