Brachiocephalic Arteriovenous Fistula after Transvenous Pacemaker Lead Extraction for Pacemaker Lead Infection

Hiroyuki Johno	Hirotaka Murata and Shouji Fujiwara

（Cardiovascular Center, Iseikai Hospital, Osaka, Japan）

Transvenous pacemaker lead extraction（TLE）techniques for pacemaker lead infection have developed in recent years. Several minimally invasive methods for TLE have been devised, but fatal complications are not rare in these procedures. We present the case of a 26-year-old woman with Brugada syndrome referred to our hospital with wound infection, 3 years after implantation. She had the 2 infected leads completely removed with laser sheaths and underwent antibiotic therapy. On post operative day 8, pulsatile mass with thrilling was noted at the suprasternal notch. Enhanced CT examination revealed the fistula between the brachiocephalic artery and vein（AVF). Operation was scheduled to close the fistula. Early in the morning of the scheduled operation day, extensive bleeding from the ruptured mass on the suprasternal notch occurred and emergency operation was done to suture the bleeding point and ligate both side of the fistula of the brachiocephalic vein, using an occlusion balloon inserted into the brachiocephalic artery. The postoperative course was uneventful. AVF after TLE is a rare complication. Although the cardiac implantable electronic device can provide life-saving benefits, device-associated complications should be managed carefully.

　

Jpn. J. Cardiovasc. Surg. 43:142-145（2014）

Keywords：pacemaker lead infection;transvenous pacemaker lead extraction;brachiocephalic arteriovenous fistula