Combined vascular and neurologic injury after cephalic vein cutdown approach for ICD implantation

Abstract

In this article we discuss two cases that highlight possible complications of cardiac device implantation. In particular, our first case involves a patient who, during implantable cardioverter defibrillator (ICD) implantation, sustained injuries to her subclavian artery and vein and subsequently developed a self-resolving neuropraxia of the brachial plexus. In our second case, the patient, also during ICD implantation, had his left cephalic vein nicked during cutdown. Post-op he then developed a hematoma-induced left brachial plexus injury that also eventually self-resolved. A literature search has not shown other incidences of iatrogenic brachial plexus injuries from ICD implantation as described.

Idiopathic brachial plexopathy after pacemaker implant

“…7 BPs have been rarely reported post cardiac implantable electronic device (CIED) implantations. [8][9][10][11][12] Possible mechanisms include injury with local anesthetic injection; injury with electrocautery while dissection; direct needle trauma during venous access; and hematoma formation leading to nerve compression. Traditionally cephalic, axillary and subclavian veins have been used for venous access.…”

Brachial plexus impingement secondary to implantable cardioverter defibrillator: A case report

“…For lead reliability (reduction in the risk of lead entrapment in the costoclavicular ligament) it is desirable to approach the vein as laterally as possible, although this increases the risk of arterial puncture or brachial plexus injury [9]. While reports of brachial plexus injury following axillary, cephalic or internal jugular approach have been described [2,5], the majority of cases are correlated with subclavian puncture. This is thought to be due to brachial plexus compromise resulting from expanding hematoma or direct trauma by the needle [10].…”

“…The device system is placed in either a subcutaneous or subpectoral pocket and consists of one or more leads attached to a generator. Brachial plexus injury following ICD placement is infrequently reported in the literature, where either injury at the time of placement or pacing lead dislodgement have been identified as the aetiological factors 2 3 4 5 . Here, we report a case of brachial plexus injury arising from irritation secondary to the pressure from both the ICD generator and the lead.…”