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Refractory axillary venous spasm during permanent pacemaker implantation.

Krishna Santosh Vemuri1, Nitin Parashar2, Dinakar Bootla1

  • 1Department of Cardiology, Postgraduate Institute of Medical Education and Research, Chandigarh, Chandigarh, India.

The Egyptian Heart Journal : (EHJ) : Official Bulletin of the Egyptian Society of Cardiology
|October 20, 2020
PubMed
Summary

Central venous spasm during pacemaker implantation is rare but can complicate cannulation. Severe venous spasms may necessitate a change in the access site for successful device implantation.

Keywords:
Axillary venous spasmCase reportComplete heart blockRefractory venous spasm

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Area of Science:

  • Cardiology
  • Vascular Surgery
  • Interventional Radiology

Background:

  • Central venous spasm is an uncommon complication during pacemaker implantation.
  • It can lead to difficulties in cannulation and may not respond to standard treatments like nitroglycerine.
  • Such events can cause patient discomfort and require alternative procedural approaches.

Purpose of the Study:

  • To report a case of severe central venous spasm during pacemaker implantation.
  • To highlight the challenges and management of this rare complication.
  • To emphasize the importance of anticipating venous spasm in difficult cannulation scenarios.

Main Methods:

  • A 72-year-old female with complete heart block underwent pacemaker implantation.
  • A venogram revealed severe spasm of the left axillary and subclavian veins, unresponsive to nitroglycerine.
  • Successful axillary vein cannulation was achieved from the contralateral side using anatomical landmarks.

Main Results:

  • Despite multiple attempts and nitroglycerine administration, the left axillary vein could not be cannulated due to severe spasm.
  • Repeat venography confirmed persistent severe venous spasm.
  • Pacemaker implantation was ultimately successful after accessing the axillary vein from the right side.

Conclusions:

  • Central venous spasm, though uncommon, should be anticipated during device implantation, especially in cases of difficult venous access.
  • Severe venous spasm may not resolve with nitroglycerine and can necessitate a change in the access site.
  • Anticipating and managing venous spasm can prevent complications such as pneumothorax and arterial injury.