Key result
Subxiphoid pericardiocentesis can rarely cause LIMA transection treatable with prompt endovascular embolization.
Why the study?
Pericardiocentesis carries risks for vascular injury, particularly in patients with coagulopathies, but left internal mammary artery injury is a rare and underrecognized complication.
Case Report (n=1)
No
Highlights a rare but critical vascular complication of subxiphoid pericardiocentesis, underscoring the importance of postprocedural monitoring particularly in patients with coagulopathies.
Heightened postprocedural vigilance is warranted after subxiphoid pericardiocentesis; extends sparse case reports on LIMA injury but leaves incidence and prevention open.
BACKGROUND: Pericardiocentesis is a common procedure for managing pericardial effusions, but it carries risks for vascular injury, particularly in patients with coagulopathies. CASE SUMMARY: A 72-year-old man with factor V Leiden mutation and sick sinus syndrome (status post pacemaker placement), presented with dizziness, dyspnea, and chest pain. Echocardiography revealed a large pericardial effusion with tamponade physiology, necessitating pericardiocentesis. After drain removal, the patient developed hypotension and bradycardia. Imaging identified active bleeding from a distal branch of the left internal mammary artery (LIMA). Hemostasis was achieved via embolization and microcoil placement. The patient recovered with no reaccumulation of effusion or hematoma. DISCUSSION: This rare case of LIMA injury following pericardiocentesis highlights an underrecognized complication, particularly in patients with coagulation disorders. It underscores the need for vigilant postprocedural monitoring and the role of advanced imaging in diagnosing vascular injuries. TAKE-HOME MESSAGE: LIMA injury is a rare but serious complication of pericardiocentesis, requiring prompt-recognition and intervention.
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Abid et al. (2025) conducted a case report in Pericardial effusion with tamponade (n=1). Pericardiocentesis was evaluated on Left internal mammary artery (LIMA) injury/transection. Pericardiocentesis via the subxiphoid approach can rarely result in left internal mammary artery transection, necessitating prompt advanced imaging and endovascular embolization.
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