Case 2
An 84-year-old woman underwent implantation of a single lead
atrioventricular (VDD) pacemaker via an axillary approach. Pectoral
swelling with an associated reduction in her hemoglobin from 12.2 g/dl
to 5.0 g/dl was noted. After 2 units of packed red blood cells were
transfused the patient was urgently taken to the operating room for
exploration of her device pocket. A hematoma was not identified during
this procedure but minor oozing from the initial puncture site was noted
and subsequently cauterized. She continued to have declining hemoglobin,
ongoing expansion of her device pocket and experienced an acute kidney
injury with creatinine increased to 202 umol/L. CT angiography was
performed which identified a chest wall hematoma with active bleeding
from a ruptured pseudoaneurysm of the left superior thoracic artery at
the site of the pacemaker lead insertion (Figure 2A). The patient
underwent emergent coil embolization of the pseudoaneurysm (Figure 2B,
C). Antiplatelet therapy was reinitiated and the patient remained stable
for the duration of their hospitalization.