Acute Innominate Vein Dissection During Pacemaker Revision Procedure: A Case Report and Conservative Management

Figures

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  Figure 1. Clinical timeline of relevant events Chronological timeline of the clinical course, spanning 21 years from initial pacemaker implantation in 2004 to the three-month follow-up after the iatrogenic venous complication. The timeline is designed to allow rapid orientation to the temporal sequence of events and their relative intervals, emphasizing the long-standing nature of the pacing system and the acute onset of the intraprocedural complication

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  Figure 2. Coronal reconstruction of chest computed tomography angiography showing complete occlusion of the left subclavian and innominate veins Coronal reconstruction of chest computed tomography angiography in venous phase. The upper arrow indicates the expected anatomical location of the left subclavian vein, demonstrating complete absence of contrast opacification. The lower arrow indicates the expected anatomical location of the left brachiocephalic (innominate) venous trunk, similarly showing absence of opacification. These findings are compatible with complete venous occlusion secondary to iatrogenic dissection. A marked asymmetry is observed when compared with the normal opacification of the contralateral right-sided venous system, which serves as an internal anatomical reference. The superior vena cava remains patent, ensuring preserved central venous return through the right-sided pathway. Systematic pericardial assessment on this study documented the absence of significant pericardial fluid collection, with normal visualization of the pericardial layers and no focal pericardial thickening, loculated effusions, or localized hematoma, confirming the resolution of the mild…

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  Figure 3. Fluoroscopic sequence of venous access via right subclavian route Temporal sequence in anteroposterior projection documenting intact patency of the contralateral venous system. (A) Initial phase showing opacification of the proximal right subclavian vein (arrow). (B) Contrast progression toward the right innominate vein (arrow). (C) Late phase evidencing continuous flow toward the superior vena cava (arrow). Uniform contrast passage without filling defects, stenosis, or obstruction confirms the anatomical viability of right-sided access for future procedures. The previous pacemaker lead is visible as a radiopaque structure