Axillary Artery Pseudoaneurysm Following Percutaneous Transaxillary Access during Cardiac Pacemaker Insertion

Percutaneous upper extremity venous access is currently the preferred approach for pacemaker insertion. A potential but rare complication is inadvertent needle puncture of an associated artery instead of the targeted vein, more so when the puncture is attempted without ultrasonography leading to formation of a pseudoaneurysm. Here, in this case report, we discuss a frail 69-year-old male patient having multiple comorbidities presenting with a tender gradually progressive right axillary swelling which he noticed following a pacemaker insertion 2 months ago. On evaluation, it was diagnosed to possibly be an iatrogenic pseudoaneurysm. He was managed using an endovascular procedure in the form of covered stent placement under fluoroscopic guidance in addition to Tisseel injection.