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Arteriovenous fistula formation after lead extraction
Mikael Hanninen1, Gary Wright, Jaimie Manlucu
1Arrhythmia Service, University of Western Ontario, London, Ontario, Canada.
The Canadian Journal of Cardiology
|October 22, 2013
Summary
Arteriovenous fistula is a rare complication following lead extraction, potentially causing acute pulmonary edema. A new continuous murmur post-extraction signals this serious risk, requiring prompt diagnosis and intervention.
Area of Science:
- Cardiology
- Vascular Surgery
- Medical Device Technology
Background:
- Lead extraction from the superior vena cava is a common procedure.
- The junction of the left brachiocephalic vein and superior vena cava is a high-risk area for complications.
- Excimer laser extraction carries risks including venous laceration and arteriovenous fistula formation.
Observation:
- A patient presented with acute pulmonary edema three days after lead extraction.
- A continuous murmur was detected near the lead extraction site.
- Invasive angiography revealed a left internal mammary artery to brachiocephalic vein fistula.
Findings:
- The arteriovenous fistula was successfully treated with coiling.
- A new continuous murmur following lead extraction is a key indicator of this complication.
- Prompt recognition and management are crucial for favorable outcomes.
Implications:
- This case highlights the importance of recognizing arteriovenous fistula as a potential complication of lead extraction.
- Continuous murmurs post-procedure warrant thorough investigation.
- Timely intervention, such as endovascular coiling, can effectively manage this rare but serious condition.
