Implantation of a Leadless Pacemaker Via a Trans-Iliac Vein Stent Approach: A Case Report

Leadless pacemakers (Micra) are typically implanted via the right femoral venous approach. However, in patients with a prior iliac vein stent, the conventional access route may carry a potential risk of stent injury. Reports of leadless pacemaker implantation through the lumen of an iliac vein stent remain limited.

An 83-year-old woman was admitted with recurrent palpitations and syncope. Ambulatory electrocardiographic monitoring revealed frequent sinus pauses, meeting the indication for permanent pacing therapy. The patient had previously undergone left iliac vein stent implantation. Intraoperative fluoroscopy demonstrated partial protrusion of the stent into the inferior vena cava. To avoid possible stent damage associated with the conventional right femoral venous approach, a decision was made to implant a VVI leadless pacemaker via the left iliac vein through the stent lumen. Under multi-angle fluoroscopic guidance, the guidewire position was carefully confirmed within the central lumen of the stent, and the delivery sheath was advanced slowly across the stented segment. The device was successfully deployed in the right ventricle. Post-procedural pacing parameters were satisfactory, and no vascular or cardiac complications occurred.

With careful patient selection and meticulous procedural technique, implantation of a leadless pacemaker via the lumen of an iliac vein stent appears to be technically feasible without immediate complications. This approach may provide an alternative therapeutic option for elderly patients with a history of iliac vein stenting who are unsuitable for the conventional femoral venous approach and are at high bleeding risk.