Rescue axillary artery covered stent during transvenous cardiac device implantation

Injury to axillary and subclavian arteries during cardiac rhythm device implantation might lead to significant mortality and morbidity especially in those with a low body mass index (BMI). We report the case of 65-year-old underweight male patient with BMI of 15.1 (height 166 cm, weight 41.8 kg) with long-standing dilated cardiomyopathy who underwent cardiac resynchronization therapy with defibrillator implantation. Left pre pectoral pocket as well as three separate axillary vein accesses were obtained smoothly. While suturing the right ventricular lead sleeve to the underlying muscle a significant amount of arterial bleed was suddenly encountered without a clear source. Traumatic injury to the axillary artery caused by the suture needle was suspected. An immediate angiography of the left axillary artery via femoral approach showed a significant axillary artery side branch leakage adjacent to the sleeve suture site. A covered stent was deployed to the axillary artery which effectively controlled the bleeding immediately. The procedure was then carried out in the usual manner. <Learning objective: Injury to axillary and subclavian arteries during cardiac rhythm device implantation might lead to significant morbidity and mortality with higher incidence in underweight patients. Endovascular covered stenting might be an effective intervention for vascular injuries during cardiac device implantation.