TEVAR for Iatrogenic Injury of the Distal Aortic Arch after Pacemaker Implantation

Introduction We report the endovascular treatment of aortic arch injury due to direct puncture during pacemaker implantation. Report After pacemaker implantation a 74-year-old woman showed a progressive decrease in haematocrit with elevation of cardiac troponin-I. Coronary angiography revealed the malposition of the catheters introduced through the aortic wall. The atrial lead was placed in the left circumflex coronary artery. Computed tomography scan confirmed distal aortic arch perforation. A Medtronic-Valiant stent–graft was implanted in the distal aortic arch while the two catheters were removed. A new VVI pacemaker was implanted and, 3 days later, the patient underwent percutaneous coronary intervention (PCI) on the dissected left circumflex artery. Four days later the patient was discharged. One-year computed tomography scan showed successful repair of the injured aorta. Discussion Endovascular stent grafting has emerged as a less invasive therapeutic alternative to treat traumatic or iatrogenic injuries of the distal aortic arch.