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Internal balloon compression: a method to achieve hemostasis when removing an inadvertently placed pacemaker lead
A J Oude Ophuis1, D J van Doorn, V A van Ommen
1Department of Cardiology, Academic Hospital Maastricht, University of Limburg, The Netherlands. ton@oude.ophuis.net
Insights
Accidental subclavian artery puncture during pacemaker lead placement can lead to arterial lead placement. This case report details the successful removal of an arterial pacemaker lead and management of complications.
Area of Science:
- Cardiology
- Vascular Surgery
- Medical Device Complications
Background:
- Subclavian vein puncture is a common procedure for central venous access and pacemaker lead insertion.
- A potential complication is inadvertent arterial entry, specifically into the subclavian artery.
- Misplacement of a pacemaker lead into an artery can result in serious systemic complications.
Observation:
- This case report details an instance where a pacemaker atrial lead was mistakenly inserted into the ascending aorta.
- The misplaced lead exhibited adequate sensing capabilities but demonstrated poor atrial capture thresholds.
- The arterial placement was not recognized during the initial procedure.
Findings:
- The mispositioned pacemaker lead in the ascending aorta was successfully removed.
- Hemostasis was effectively achieved using intraarterial balloon compression.
- The intervention was performed via the brachial artery approach.
Implications:
- Highlights the critical importance of recognizing and managing inadvertent arterial placement of pacemaker leads.
- Demonstrates a successful technique for lead removal and complication management in such scenarios.
- Emphasizes the potential risks associated with central venous access and pacemaker implantation procedures.
Abstract:
One of the possible complications of subclavian vein puncture is entry into the subclavian artery. If this is not recognized, a pacemaker lead may be placed arterially. Since this may lead to systemic emboli, the pacemaker lead must be removed. This case report describes a patient in whom an atrial lead was inadvertently placed in the ascending aorta, where it had good sensing values but poor atrial capture threshold values. This lead was subsequently removed and hemostasis was achieved with intraarterial balloon compression via the brachial artery.
