Step-By-Step: Subclavian Venoplasty to Facilitate Cardiac Implantable Electronic Device Upgrade

Lead-related venous obstruction is a significant complication of chronic indwelling transvenous leads, which poses unique challenges during cardiac device upgrades.

The anatomical sequelae of venous occlusion are variable and carry important procedural implications. Occlusions can develop in any part of the venous system, but they most often occur in the subclavian and innominate veins, while the superior vena cava is less frequently affected.

In this review, we describe approaches to lead-related venous occlusion providing step-by-step procedural guidance.

Venoplasty, neovascular channel creation are two main techniques for addressing lead-related venous obstruction.

Venoplasty in the setting of an indwelling pacemaker or defibrillator leads can be performed safely and effectively. The difficulty of the procedure lies in crossing the obstruction. Familiarity with various tools is needed for a successful outcome.