Percutaneous closure of iatrogenic arteriovenous fistula after pacemaker implantation

A 76-year-old man presented with swelling of the left upper limb that started 1 year after pacemaker implantation. During the procedure, a single-pass VDD lead was introduced through an axillary vein puncture and was positioned in the right ventricular apex. Pitting oedema of the left upper limb was seen, with reddish-brown skin pigmentation, scaling and thickening (figure 1A). Subclavian angiography showed a connection between the left axillary artery and vein (figure 1B). A self-expanding covered stent was deployed across the fistula. Postprocedure angiogram showed minimal residual shunt (figure 2A, online supplementary video 1online supplementary video 1). At 4 months, there was significant reduction in the oedema of the left upper limb (figure 2B). Figure 1Presentation. (A) Massive oedema of the left upper limb is seen. (B) Subclavian angiography shows the fistulous connection between the left axillary artery and...
Source: Heart Asia - Category: Cardiology Authors: Tags: Images in cardiovascular medicine Source Type: research