Bleeding complications after pacemaker implantation pose risks, including infection and prolonged hospital stay. A case involving intramural aortic hematoma (IMH) arising from subclavian vein access during implantation and concomitant acute pulmonary embolism (PE) is presented. In the present case, IMH probably resulted from subclavian artery vasa vasorum trauma during vein puncture and guidewire advancement, leading to IMH and hemothorax. PE possibly stemmed from a prothrombotic state caused by intervention and IMH. A conservative management with seriate CT scans was chosen due to hemodynamic stability and high surgical risk, with IMH resolution confirmed on follow-up.