Iatrogenic Axillary Arteriovenous Fistula After Pacemaker Implantation

A 71-year-old woman with a history of second-degree atrioventricular block underwent dual-chamber pacemaker implantation via the left axillary vein. The procedure was uneventful, and the patient remained asymptomatic.

One year later, she was referred for elective coronary angiography following the detection of a new continuous murmur. Transthoracic echocardiography showed preserved biventricular systolic function, no significant valvular disease, and only mild mitral regurgitation. Coronary angiography demonstrated normal coronary arteries. Careful reassessment of the physical examination localized the murmur to the left axillary region, radiating to the ipsilateral neck and shoulder.

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