Spontaneous migration of a peripherally inserted central catheter into the azygos vein with accidental transection during thoracoscopic esophagectomy: a case report

This case report describes a rare adverse event involving the spontaneous migration of a peripherally inserted central catheter (PICC) into the azygos vein, followed by its accidental transection during thoracoscopic radical esophagectomy. A 73-year-old male patient with esophageal squamous cell carcinoma underwent left-sided PICC placement for neoadjuvant therapy, with correct tip position confirmed by intracavitary electrocardiography and chest X-ray. While during the surgery, the migrated PICC was inadvertently transected when the surgeon divided the azygos vein with a stapling device. The catheter was retrieved, and the azygos vein stump was re-sutured. This report analyzes the probable multifactorial causes of PICC migration and proposes a multi-disciplinary prevention framework encompassing the surgeon, anesthesiologist, and nursing staff to mitigate the risk of both central-venous catheter malposition and device fracture.