Refractory axillary venous spasm during permanent pacemaker implantation
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Vemuri et al. The Egyptian Heart Journal (2020) 72:71 https://doi.org/10.1186/s43044-020-00102-z
CASE REPORT
Open Access
Refractory axillary venous spasm during permanent pacemaker implantation Krishna Santosh Vemuri1, Nitin Parashar2, Dinakar Bootla1, Pruthvi C. Revaiah1, Kewal Kanabar1, Krishna Prasad Nevali1, Yash Paul Sharma1, Ganesh Kasinadhuni1 and Prashant Panda1*
Abstract Background: Vascular spasm is well known to occur in the arterial system. Central venous spasm during pacemaker implantation is uncommon with only a few cases reported from time to time. Sometimes, the venous spasms may not respond to nitroglycerine injections which requires a change of access site and undue discomfort for the patient. Case presentation: A 72-year-old female patient with no prior comorbidities presented to us with recurrent dizziness on exertion and at rest. The electrocardiogram showed complete heart block, likely to be of sclerodegenerative etiology as the patient did not have any ischemic symptoms, also the electrocardiogram and echocardiogram did not show any evidence of ischemia. As part of the hospital protocol, a venogram was performed by giving intravenous diluted contrast (iohexol) through the left brachial vein, which showed good-sized axillary and subclavian veins. We attempted to cannulate the left axillary vein with a 16G needle using Seldinger technique, but the axillary vein could not be cannulated despite multiple attempts. We gave incremental boluses of intravenous nitroglycerine, despite that the left axillary vein could not be cannulated. Repeat intravenous contrast injection showed severe spasm of axillary and subclavian veins. Finally, the axillary vein was cannulated from the right side using anatomical landmarks and a pacemaker was implanted. Conclusions: Venous spasm during device implantation although uncommon, it should be anticipated in patients with difficult cannulation to prevent inadvertent complications like pneumothorax and arterial injuries. Mild venous spasm may relieve with time but severe venous spasm may require a change of access site Keywords: Complete heart block, Axillary venous spasm, Refractory venous spasm, Case report
Background Vascular spasm is commonly known to occur in the arterial system. Central venous spasm during pacemaker implantation is quite uncommon, with only a few cases reported previously in the literature. Moreover, venous spasms might not respond to nitroglycerin which is commonly used as a successful therapeutic agent for arterial spasms. Venous spasm may be related to the chemical effect of a contrast agent or the mechanical effect of multiple punctures and guidewire placement. * Correspondence: [email protected] 1 Department of Cardiology, Postgraduate Institute of Medical Education and Research, Chandigarh, Chandigarh, India Full list of author information is available at the end of the article
Case presentation
A 72-year-old female patient having no prior comorbidities presented to us with recurrent episodes of dizziness both on exertion as
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