Key result
A 65-year-old man developed hemoptysis and alveolar hemorrhage immediately following a difficult subclavian vein puncture for pacemaker implantation, which resolved with conservative management.
Why the study?
Subclavian venous access for pacemaker lead insertion carries complication risks ranging from hematoma to pneumothorax, and the authors describe a rare presentation of hemoptysis following difficult puncture.
Case Report (n=1)
Hemoptysis is a rare but mostly benign complication of subclavian venepuncture for pacemaker implantation that typically resolves with conservative management.
Hemoptysis may follow difficult subclavian access yet resolve conservatively; leaves open optimal preventive strategies.
Background: Subclavian venous access for pacemaker lead insertion is a common procedure and is normally considered safe in the hands of an expert. However, subclavian venepuncture is not without complications, starting from mild subcutaneous hematoma to pneumothorax. We here present a case of hemoptysis occurring after difficult subclavian vein puncture, which subsequently improved on conservative management only. Case Summary: A 65-year-old gentleman, post aortic valve replacement had persistent high-grade AV block and was taken up for a dual chamber pacemaker implantation. Immediately following venous access, he had a bout of hemoptysis, which recovered on its own. Post procedure chest x-ray was suggestive of alveolar hemorrhage which cleared gradually in next three-four days. Discussion: Post subclavian venepuncture hemoptysis is known; but it is a rare complication, arising either because of lung parenchyma injury or arterial injury. This is mostly benign and improves on conservative management only; however rarely it may be massive and life threatening where transcatheter arterial embolization may be required.
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Bagchi et al. (2019) conducted a case report in High-grade AV block (n=1). Subclavian vein puncture for pacemaker implantation was evaluated on Hemoptysis and alveolar hemorrhage. A 65-year-old man developed hemoptysis and alveolar hemorrhage immediately following a difficult subclavian vein puncture for pacemaker implantation, which resolved with conservative management.
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