Internal Mammary Arterial Injury from Lead Extraction: A Clinically Subtle yet Important Complication of Implantable Device Removal

Figure 3

The relationship of the clavicle, first rib, IMA, and subclavian vessels is shown. A common “problem area” for extraction is the region of intersection of the clavicle and first rib (dashed white box). This region is a common site of lead insertion and can have significant fibrosis, calcification, and lead angulation (inset panel). Lead angulation is a main reason for extraction sheaths to deviate from their coaxial course and thus cause trauma to adjacent structures. A cross-section schematic at the point of IMA takeoff from the subclavian artery reveals its proximity to the adjacent vein and its potential for trauma (right lower panel).