Transiliac vein approach to a permanent pacemaker implantation after aortic valve reoperation

Permanent pacemaker lead implantation via azygous vein in a patient with silent superior vena cava syndrome

Occlusion of the superior vena cava is a rare but serious complication of transvenous endocardial pacing. We describe an unusual approach for permanent pacemaker implantation using the azygous vein in a patient with occlusion of the bilateral total subclavian and innominate veins after previous bilateral pectoral pacemaker implantation. Endocardial pacing using the azygous vein with minimal invasive thoracotomy may be a good option for patients with inaccessible subclavian route.

Permanent Transfemoral Pacemaker: A Single-Center Series Performed with an Easier and Safer Surgical Technique

INTRODUCTION

When venous access via the upper venous tree is not possible, the usual approach is to proceed to epicardial lead placement.

MATERIAL AND METHODS

This report presents a consecutive series of 12 permanent pacemaker systems utilizing the right femoral vein for venous access implanted between May 2001 and October 2004.

RESULTS

A modification of the previously reported surgical technique was used with a mean implant time of 52 minutes. Five were dual-chamber systems and seven were VVIR. All the leads implanted were active fixation. There was a 0% dislodgment rate and a mean follow-up of 18 months. During this time, three patients required revision or treatment of a pocket complication. All systems remained in the pacing mode as originally programmed with stable low sensing and pacing thresholds. There was no clinical evidence for acute or chronic venous thrombosis and no evidence of asymptomatic venous obstruction in eight patients who underwent echo-duplex studies.

CONCLUSION

We believe that the permanent femoral implant utilizing the technical modifications described in this article, offers an alternative to epicardial lead placement when the usual upper venous tree access is not available.

Defibrillator implantation via the iliac vein

We describe a 23-year-old patient with idiopathic dilated cardiomyopathy in whom an implantable cardioverter defibrillator was implanted via the right external iliac vein. Addition of a subcutaneous patch was required to obtain an adequate safety margin for defibrillation.

Permanent transfemoral pacemaker implantation is the technique of choice for patients in whom the superior vena cava is inaccessible

We describe transfemoral pacemaker implantation in three patients in whom pacing via the superior vena cava was not possible or suboptimal. The first was an 88-year-old man with superior vena cava obstruction presenting with fractured epicardial pacing leads. Recent pneumonia increased the risks of a general anesthetic. The second patient was a 57-year-old man who was intolerant of a pectorally sited pacemaker because of the thinness of his anterior chest wall. The third patient was a 69-year-old woman who presented with an infected eroding pectorally sited pacemaker. Scarring secondary to a previous pacemaker infection rendered the contralateral pectoral site inaccessible. Since the subclavian route was inaccessible (case 1) or suboptimal (case 2 and 3), we implanted transvenous pacemakers via the femoral route, which was safe, and effective, during a 6-month follow-up period.

Transiliac permanent pacemaker implantation after extraction of infected pectoral pacemaker systems

Infected pectoral pacemaker systems were extracted in 5 patients and new pacemakers were reimplanted in a pelvic pocket through the iliac veins. In patients who have infected pectoral pacemaker systems, this easy and safe technique provides an alternate route for reimplantation of permanent pacemakers.