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Published on: February 28, 2012
A case report of successful permanent pacemaker implantation via the iliac vein
Tetsuo Yamaguchi1, Takamichi Miyamoto1, Yasuteru Yamauchi1
1Department of Cardiology, Japanese Red Cross Musashino Hospital, 1-26-1, Kyonancho, Musashino City, Tokyo 180-8610, Japan.
Unlabelled:
An 85-year-old man was referred to our hospital with a pacemaker pocket infection. A permanent pacemaker had been implanted via the right subclavian vein. The pacemaker and pacing leads were removed and a temporary pacemaker was implanted. After vancomycin treatment for 4 weeks, pacemaker implantation via the right external iliac vein was performed under local anesthesia because of left subclavian vein occlusion, infection of the right pocket, and difficulty with epicardial lead insertion. The iliac vein approach is an effective alternative in patients in whom the pectoral approach cannot be used.
Learning Objective:
Permanent pacemaker implantation using the conventional pectoral approach is impossible or contraindicated in 1-6% of patients. In such patients, implantation via the iliac vein is considered an effective alternative. The advantages of this approach are that the wound size and bleeding amount are very small and that it can be performed under local anesthesia. Therefore, this approach can be used in patients with a poor general condition, including elderly patients.
Insights
Pacemaker implantation via the iliac vein is an effective alternative for patients unsuitable for the pectoral approach. This method offers a minimally invasive option, especially for elderly patients with complex conditions.
Area of Science:
- Cardiology
- Medical Devices
Background:
- Permanent pacemaker implantation is typically performed via the pectoral approach.
- In 1-6% of patients, the pectoral approach is impossible or contraindicated due to various complications or patient factors.
Purpose of the Study:
- To evaluate the effectiveness of the iliac vein approach for permanent pacemaker implantation.
- To present an alternative strategy for patients where the conventional pectoral approach is not feasible.
Main Methods:
- A case report detailing pacemaker pocket infection and subsequent lead removal.
- Temporary pacemaker implantation followed by antibiotic treatment.
- Permanent pacemaker implantation via the right external iliac vein under local anesthesia due to subclavian vein occlusion and pocket infection.
Main Results:
- The iliac vein approach was successfully employed for permanent pacemaker implantation.
- This method proved effective in a patient with prior pacemaker complications and venous access issues.
- The procedure was performed under local anesthesia with minimal invasiveness.
Conclusions:
- The iliac vein approach is a viable and effective alternative for permanent pacemaker implantation when the pectoral approach is contraindicated.
- This technique is particularly beneficial for elderly patients or those with poor general health, offering reduced wound size and bleeding.
