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. 2019;46(6):594-598.
doi: 10.5999/aps.2018.01158. Epub 2019 Apr 26.

Brachial plexus impingement secondary to implantable cardioverter defibrillator: A case report

Natalie Jumper  1 , Ishan Radotra  1 , Paulina Witt  1 , Niall G Campbell  2 , Anuj Mishra  1
Affiliations

Brachial plexus impingement secondary to implantable cardioverter defibrillator: A case report

Natalie Jumper et al. Arch Plast Surg. 2019.

Abstract

Overall complication rates of 9.1% have been reported following implantable cardioverter defibrillator (ICD) placement. Brachial plexus injury is infrequently reported in the literature. We describe a 26-year-old female experiencing left arm nerve pain, a positive Tinel's sign, numbness in the median nerve distribution of the hand and biceps muscle weakness following revision ICD via subclavian vein approach. Nerve conduction studies identified severe partial left brachial plexopathy, which remained incompletely resolved with conservative management. Surgical exploration revealed lateral cord impingement by the ICD generator and a loop of the ICD lead, along with fibrosis, necessitating surgical neurolysis and ICD generator repositioning. As increasing numbers of patients undergo cardiac device implantation, it is incumbent on practitioners to be aware of potential increases in the prevalence of this complication.

Keywords: Brachial plexus; Brachial plexus neuropathies; Defibrillators, implantable.

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Conflict of interest statement

No potential conflict of interest relevant to this article was reported.

Figures

Fig. 1.
Fig. 1.. Contrast neck CT images
Axial plane computed tomography (CT) image. (A) Loop of implantable cardioverter defibrillator (ICD) lead identified in left infraclavicular space (yellow arrow). (B) ICD box identified in left infraclavicular space (yellow arrow). (C, D) Coronal plane CT image. Yellow arrows indicate laterally directed loop lead of ICD in left infraclavicular space.
Fig. 2.
Fig. 2.. Intraoperative images of ICD repositioning
(A) Access through original left infraclavicular incision. (B) Dissection into subpectoral pocket revealed the implantable cardioverter defibrillator (ICD) lead loop (yellow arrow) from computed tomography and the laterally situated ICD generator (blue arrow). (C) Once the box (blue arrow) was dissected out the loop of ICD lead (yellow arrow) remained tethered by fibrotic scar tissue (green arrow) necessitating neurolysis. (D) Following careful dissection, the loop was freed from the brachial plexus and the box and lead re-positioned. The forceps here is indicating the lateral cord of the brachial plexus.
See this image and copyright information in PMC

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