Successful Minimally Invasive Management of Complex Vascular Access-Related Complications following Leadless Pacemaker Implantation

Abstract

The management of acute limb ischemia, femoral artery pseudoaneurysm, and arteriovenous fistula formation following leadless pacemaker implantation presents a unique clinical challenge. This case report outlines a combined endovascular approach that integrates diagnostic imaging with therapeutic interventions to address these complications effectively. The proposed strategy includes endovascular stent deployment, intra-arterial thrombolytic therapy, and mechanical thrombectomy to restore perfusion in cases of acute limb ischemia. This multidisciplinary approach minimizes the need for open surgical repair. These findings underscore the efficacy of a coordinated endovascular strategy in managing complex vascular complications associated with the use of large-bore femoral sheaths.

Keywords

large bore femoral access - arteriovenous fistula - pseudoaneurysm - acute limb ischemia - thrombectomy - catheter-directed thrombolysis - covered stent

Publication History

Received: 22 March 2025

Accepted: 27 July 2025

Article published online:
01 September 2025

• References

• 1 Kelm M, Perings SM, Jax T. et al. Incidence and clinical outcome of iatrogenic femoral arteriovenous fistulas: implications for risk stratification and treatment. J Am Coll Cardiol 2002; 40 (02) 291-297
• 2 Hetrodt J, Engelbertz C, Gebauer K. et al. Access site related vascular complications following percutaneous cardiovascular procedures. J Cardiovasc Dev Dis 2021; 8 (11) 136
• 3 Joglar JA, Chung MK, Armbruster AL. et al; Peer Review Committee Members. 2023 ACC/AHA/ACCP/HRS guideline for the diagnosis and management of atrial fibrillation: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation 2024; 149 (01) e1-e156
• 4 Alexandre K. Endovascular management of a large femoral pseudoaneurysm: a case report and literary review. Cureus 2022; 14 (03) e23045
• 5 Kupó P, Pap R, Sághy L. et al. Ultrasound guidance for femoral venous access in electrophysiology procedures-systematic review and meta-analysis. J Interv Card Electrophysiol 2020; 59 (02) 407-414
• 6 Bin Waleed K, Leung LW, Akhtar Z, Sohal M, Zuberi Z, Gallagher MM. New approaches to achieving hemostasis after venous access in cardiovascular patients. Kardiol Pol 2022; 80 (7-8): 750-759
• 7 Gooneratne T, Chanaka KAN, Wijeyaratne SM. An unusual case of femoral arteriovenous fistula associated with acute limb ischemia following femoral vein catheterization for hemodialysis. J Vasc Bras 2022; 21: e20210199
• 8 Stolt M, Braun-Dullaeus R, Herold J. Do not underestimate the femoral pseudoaneurysm. Vasa 2018; 47 (03) 177-185