Rare Anomalous Left Brachiocephalic Venous Drainage Affecting Pacemaker Placement

Area of Science:

• Cardiology
• Thoracic Surgery
• Vascular Anatomy

Background:

• Severe aortic stenosis and atrial fibrillation necessitated dual-chamber pacemaker implantation.
• Anatomical variations in thoracic veins can complicate vascular interventions.
• Congenital venous anomalies are often clinically silent but can present challenges.

Purpose of the Study:

• To report a rare case of an accessory hemiazygos vein encountered during pacemaker implantation.
• To emphasize the importance of identifying aberrant venous systems in thoracic procedures.
• To highlight potential challenges in minimally invasive thoracic surgery due to venous anomalies.

Main Methods:

• Case report of an 88-year-old male patient undergoing elective pacemaker implantation.
• Intraoperative discovery of an aberrant venous system during guidewire manipulation.
• Review of literature regarding similar thoracic vein anomalies.

Main Results:

• An accessory hemiazygos vein draining into the azygous vein was identified, obstructing guidewire advancement.
• The patient's anomaly was a rare variant of upper body venous return.
• This specific anomaly has been documented only twice previously in medical literature.

Conclusions:

• Congenital anomalies of thoracic veins, though rare, require careful consideration during vascular interventions.
• Recognition of these anatomic variants is critical for the safety and success of procedures like pacemaker and central line insertion.
• This case underscores the need for vigilance in identifying and managing unexpected venous anomalies in thoracic surgery.