Hemoptysis after subclavian vein puncture for pacemaker implantation: A case report
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Abstract
Background: Subclavian venous access for pacemaker lead insertion is a common procedure and is normally considered safe in the hands of an expert. However, subclavian venepuncture is not without complications, starting from mild subcutaneous hematoma to pneumothorax. We here present a case of hemoptysis occurring after difficult subclavian vein puncture, which subsequently improved on conservative management only.
Case Summary: A 65-year-old gentleman, post aortic valve replacement had persistent high-grade AV block and was taken up for a dual chamber pacemaker implantation. Immediately following venous access, he had a bout of hemoptysis, which recovered on its own. Post procedure chest x-ray was suggestive of alveolar hemorrhage which cleared gradually in next three-four days.
Discussion: Post subclavian venepuncture hemoptysis is known; but it is a rare complication, arising either because of lung parenchyma injury or arterial injury. This is mostly benign and improves on conservative management only; however rarely it may be massive and life threatening where transcatheter arterial embolization may be required.
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Solomon N, Escher DJ. A rapid method for insertion of the pacemaker catheter electrode. Am Heart J. 1963; 66: 717–718. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/14083795
McNeill GP, Taylor NC. Use of subclavian vein for permanent cardiac pacing. Br Heart J. 1978; 40: 114–116. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/637961
Kirk AJ, Turner MA. Surgical aspects of permanent cardiac pacemakers. Life Support Syst. 1987; 5: 223–231. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/3695582
Kossaify A, Nicolas N, Edde P. Hemoptysis after subclavian vein puncture for pacemaker implantation: importance of wire-guided venous puncture. Clin Med Insights Case Rep. 2012; 5:119-122. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/22859867
Talwar KK, Agarwal R, Rao YV. Permanent pacing by percutaneous subclavian vein in small children. Am Heart J. 1991; 122: 1796. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/1957790
García-Anguiano Duque F, Marchena Gómez J, Servent Pedescoll R. Hemoptysis, a rare complication of punction-catheterization of the subclavian vein. Rev Clin Esp. 1994; 194: 202. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/8008962
Goldberg A, Inna Rosenfeld I, Marmor A. Hemoptysis—a rare complication of pacemaker implantation. Indian Pacing Electrophysiol J. 2008; 8: 75-76. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/18270606
Antonelli D, Atar S, Bloch L. Hemoptysis after subclavian vein puncture. Harefuah. 2007; 146: 744. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/17990384
Truong AT, Brown DL. Catastrophic hemothorax from lobar pulmonary artery puncture during attempted subclavian vein catheterization: the fallibility of venous blood aspiration. J Clin Anesth. 2009; 21: 377-378. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/19700295
Holt S, Kirkham N, Myerscough E. Haemothorax after subclavian vein cannulation. Thorax. 1977; 32: 101-103.
Yelgec NS, Osken A, Turkkan C, Alper AT. Subclavian vein puncture-induced massive pulmonary hemorrhage and hemoptysis during pacemaker implantation. North Clin Istanb. 2018; 5: 254-255. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/30688923
Tokue H, Tokue A, Morita H, Yoshito T. Successful Interventional Management for Pulmonary Arterial Injury Secondary to Pacemaker Implantation. Case Rep Cardiol 2016; 2016:1–3. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/27882248
Dora SK, Kumar VK, Bhat A, Tharakan JA. Venogram-guided extrathoracic subclavian vein puncture. Indian Heart J. 2003; 55:637-640. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/14989516
Burri H, Sunthorn H, Dorsaz PA, Shah D. Prospective study of axillary vein puncture with or without contrast venography for pacemaker and defibrillator lead implantation. Pacing Clin Electrophysiol. 2005; 28 Suppl 1: S280-283. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/15683516