Iatrogenic subclavian arteriovenous fistula during permanent pacemaker implantation: Closed by endovascular coiling

Abstract

Iatrogenic arteriovenous fistula is a unique complication during pacemaker implantation. A 55‐year‐old man was posted for pacemaker implantation for recurrent unexplained syncope with trifascicular AV block. After axillary/subclavian venous puncture and introduction of RV lead, arterial spurting was immediately noticed as the the sheath was peeled away. After dissecting the overlying pectoralis muscle, deep sutures and manual compression achieved hemostasis. However, Subclavian arteriogram revealed an arteriovenous fistula from a lateral thoracic artery branch to the innominate vein. Hilal coils were deployed near the fistulous orifice, leading to complete resolution of the leak. After 3 days, pacemaker was implanted from right side. A multidisciplinary approach was the key to successful outcome.

Internal jugular vein fistula mimicking dural arteriovenous fistula after cardiac pacemaker placement

“…A few cases of arteriovenous fistulae have been reported after AICD placement, and arteriovenous fistulae arising from central line placement, procedures requiring cannulation of the internal jugular vein, and trauma are also documented [4] , [5] , [6] – 7] . Some authors have posited that this may arise in iatrogenic settings as a consequence of inadvertent “double puncture” involving both the internal jugular vein and carotid artery [2] .…”

An unusual cause of pocket hematoma: Injury to a superior thoracic artery branch

“…The incidence of injury to branches of the axillary artery during pacemaker implantation is not known. There are only a few cases described in the literature, 1 , 2 , 3 and only 1 of these to the superior thoracic artery. Given the fact that most hematomas are initially managed conservatively without angiographic imaging, the incidence of arterial injury and its role in postimplant hematoma is not known.…”

Iatrogenic Arteriovenous Fistula

“…AVF post-pacemaker implantation is extremely rarely reported in the literature. 1 No large case series exists to reveal the true incidence of this complication. In this limited literature, symptoms such as excessive bleeding during implantation or ipsilateral arm swelling should raise suspicion that an arteriovenous vascular injury has occurred.…”