Facilitation of the subclavian-introducer technique with contrast venography

The subclavian-introducer technique is a rapid and easily performed method of obtaining venous access for implanting permanent pacemaker electrodes. Although this technique has facilitated the participation of nonsurgeons in pacemaker implantation, the potential for complications is increased over the venous cutdown approach. This is particularly true in difficult cases, such as those with prior lead implants, venous thrombosis, or anomalous venous return. This article describes the use of contrast venography for facilitating an otherwise "blind" subclavian venipuncture. This method should make use of the subclavian-introducer technique safer.