Endovascular Management of an Acquired Subclavian Arteriovenous Fistula Secondary to Chronic Venous Occlusion after Pacemaker Insertion

Subclavian arteriovenous (AV) fistula formation is a rare complication of chronic deep vein thrombosis after pacemaker insertion. Here we present the case of an 80-year-old woman who developed a symptomatic arteriovenous fistula more than two years after cardiac pacemaker insertion, as a result of chronic thrombotic stenosis of the left subclavian vein. The defect was managed endovascularly by embolization, balloon angioplasty, and stent graft insertion, in order to both close the fistula and recanalize the subclavian vein to prevent recurrence. In this case report we present the endovascular procedure undertaken, followed by a discussion of the relevant pathophysiology, treatment options, and approach considerations.