Arteriovenous fistula formation after lead extraction.

The junction between the left brachiocephalic vein and the superior vena cava is a high-risk region during lead extraction. Venous laceration with hemodynamic collapse is the most feared complication arising in this region, but arteriovenous fistula formation after excimer laser extraction also has been reported. A case of arteriovenous fistula presenting 3 days after extraction with acute pulmonary edema is described. A continuous murmur was heard near the extraction site and invasive angiography demonstrated a left internal mammary artery to the brachiocephalic vein fistula, which was coiled. A new continuous murmur after lead extraction is the hallmark of this rare complication.