LAUSR

A 46-year-old male patient who was a known case of sick sinus syndrome had permanent pacemaker placement one month back. One week post procedure, the patient developed swelling at the site of pacemaker placement along with mild fever. Ultrasound Doppler examination revealed the presence of a partially thrombosed pseudoaneurysm in relation to a branch of the left axillary artery (Figure 1(A)). The patient was put on broad-spectrum antibiotics and close follow-up till he became afebrile and then planned for embolisation of the pseudoaneurysm. Diagnostic angiogram with the catheter tip in the left subclavian artery ostium (Figure 1(B)) demonstrated the pseudoaneurysm arising in close relation to the axillary artery. Selective injection from the left brachial approach confirmed its origin from the superior thoracic branch of the left axillary artery (Figure 1(C)). The neck of the pseudoaneurysm was occluded using gel foam pledgets. Check angiograms post embolisation showed no filling of the pseudoaneurysm (Figure 1(D)). A pseudoaneurysm is a rare complication after pacemaker placement procedures. Its occurrence has previously been reported in a few case reports only where they described these rare entities arising from an axillary artery or the internal mammary artery. However, pseudoaneurysm from the superior thoracic artery has not been described so far. Because of the risk of expansion and rupture, prompt repair is indicated in these cases. Endovascular management is preferred in these lesions as surgery may entail the risk of injury to neurovascular bundle. Endovascular treatment options may include ultrasound-guided thrombin injection, embolisation or stent graft placement.