Angioplasty in Patients with Central Venous Occlusion Prior to Device Lead Implantation

Venous stenosis or occlusion often hinders transvenous cardiac device lead implantation, especially in patients with prior devices or long-term venous access. Surgical alternatives and femoral routes carry higher risk. We retrospectively evaluated percutaneous transluminal angioplasty (PTA) in 11 patients with significant venous obstruction. Recanalization was successful in 10/11 cases (91%). Eight leads were implanted immediately, two delayed, with one re-occlusion linked to delay. No peri-procedural complications occurred. Technical success was defined as successful lead implantation through the recanalized vein; clinical success was defined as absence of subclavian venous syndrome (no arm pain or swelling) during follow-up. During follow-up, no symptomatic re-occlusion was observed. PTA appears safe and effective, with same-session lead implantation minimizing re-occlusion risk, offering a valuable alternative when conventional venous access is not feasible.