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[Permanent pacemaker lead insertion for totally occluded subclavian vein]

T Ohta¹, S Okumura, M Fujioka

¹Department of Thoracic Cardiovascular Surgery, Mimihara General Hospital, Osaka, Japan.

Kyobu Geka. the Japanese Journal of Thoracic Surgery

|April 1, 1994

Summary

This study reports successful permanent pacemaker implantation in four patients with total subclavian vein occlusion. Alternative venous routes were used, demonstrating feasibility despite venous abnormalities.

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Area of Science:

Cardiology
Vascular Surgery
Medical Devices

Background:

Permanent pacemaker implantation typically relies on subclavian vein access.
Subclavian vein occlusion can present a significant challenge for lead placement.
Pre-existing venous abnormalities may not be clinically apparent before device implantation.

Observation:

Four patients with total subclavian vein occlusion underwent successful permanent pacemaker implantation.
Diverse venous access routes were utilized, including contralateral subclavian vein, internal jugular vein, and passage through occluded innominate vein.
Phlebography-guided venipuncture proved effective even with mid-subclavian vein occlusion.

Findings:

Successful pacemaker implantation is achievable in patients with total subclavian vein occlusion.

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Alternative venous access strategies can overcome significant venous obstructions.

Preoperative phlebography is crucial for identifying venous pathologies that could complicate pacemaker procedures.

Implications:

These findings expand the options for pacemaker implantation in patients with challenging venous anatomy.
The study highlights the importance of thorough preoperative venous assessment.
Successful management of these cases may improve patient outcomes and reduce procedure-related complications.