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Updated: Apr 20, 2026

Upper-extremity Approach for Secondary Access in Transfemoral Transcatheter Aortic Valve Implantation
Published on: August 8, 2025
Permanent pacemaker implantation using a femoral approach
Patrícia Rodrigues1, Hipólito Reis1, Vítor Lagarto1
1Serviço de Cardiologia, Centro Hospitalar do Porto, Porto, Portugal.
Insights
This study presents a rare pacemaker implantation technique using the femoral vein when standard upper body veins are blocked. This approach offers a viable alternative for patients requiring cardiac pacing.
Area of Science:
- Cardiology
- Vascular Surgery
Background:
- Permanent pacemaker implantation typically relies on the cephalic or subclavian veins for venous access.
- Occlusion or non-patency of these standard venous access routes presents a significant challenge for pacemaker procedures.
Observation:
- Two cases are detailed where femoral vein access was successfully utilized for permanent pacemaker implantation.
- This alternative route was chosen due to non-patent cephalic and subclavian veins in both patients.
Findings:
- Femoral vein access provides a feasible alternative for pacemaker implantation when upper venous access is compromised.
- The review covers the specific technique, appropriate patient selection (indications), benefits, and potential risks (complications) of this method.
Implications:
- This technique expands the options for pacemaker implantation in complex venous anatomy cases.
- It highlights the importance of considering alternative venous access routes to ensure timely and effective cardiac pacing therapy.
Abstract:
We describe two cases in which a permanent pacemaker was implanted via the femoral vein, because the cephalic and subclavian veins were not patent. The technique and its indications, advantages and potential complications are reviewed.
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