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[Permanent pacemaker lead insertion for totally occluded subclavian vein]
1Department of Thoracic Cardiovascular Surgery, Mimihara General Hospital, Osaka, Japan.
Insights
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.
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.
- 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.
Abstract:
We experienced 4 patients with total occlusion of the subclavian vein in whom permanent pacemakers were implanted. Occlusion of the subclavian vein was not clinically apparent in these 4 patients. The pacing lead was inserted through the contralateral subclavian vein in a 65-year-old male. In a 80-year-old male, the pacing lead was inserted trough the internal jugular vein because of occlusion of both subclavian veins. The pacing lead was passed through the occluded portion of the innominate vein in a 84-year-old male. Phlebography-guided venipuncture was not difficult in a 79-year-old female whose mid-portion of the subclavian vein was occluded. All patients have done well since permanent pacemaker implantation. Preoperative phlebography should be performed as it may provide useful information concerning pathological alterations in the venous system that might hinder smooth implantation of the pacemaker. A review of the literature revealed no reports concerning methods in which pacing leads are passed through totally occluded portions of the subclavian vein. We here report 4 patients with total occlusion of the subclavian vein in whom permanent pacemakers were implanted via different venous routes.