Pinch-off syndrome–related port catheter migration requiring surgical extraction combined with coronary artery bypass grafting

Pinch-off syndrome is a rare but potentially serious complication of subclavian venous port systems, resulting from mechanical compression between the clavicle and first rib and leading to catheter fracture and embolization. A 63-year-old man with lung cancer presented with a fractured port catheter that had migrated into the left main and lower lobe pulmonary arteries. Endovascular retrieval was attempted but was unsuccessful due to firm endothelial adhesion. Preoperative coronary angiography revealed concomitant significant coronary artery disease. The patient subsequently underwent successful surgical catheter extraction combined with coronary artery bypass grafting. This case illustrates a Grade 3 pinch-off syndrome and highlights the limitations of percutaneous techniques in chronically embedded catheters. It also demonstrates that a combined surgical approach can be a safe and effective strategy in selected patients.