Axillary Vein Spasm During Permanent Pacemaker Implantation

This case example illustrates the challenging nature of managing axillary vein spasm. Once axillary vein spasm has been diagnosed, unnecessary attempts at venous puncture should be avoided as this can result in worsening of the spasm. Intravenous fluids should be infused from the ipsilateral venous access. Intravenous nitroglycerin from the ipsilateral access in incremental doses of 100-200 μg can help in relieving the spasm. It is imperative to wait for 5-10 minutes before re-attempting puncture. A repeat venogram should be performed to demonstrate resolution of spasm and guide the puncture. If spasm persists, puncture may be attempted in the medial part of the axillary vein or the subclavian vein. In refractory cases where the above measures fail, contralateral venous access may be required.