Venoplasty of a chronic venous occlusion allowing for cardiac device lead placement: A team approach

Abstract

In patients with complete venous occlusion requiring venous access for cardiac device lead placement, venous revascularization is a viable option. A percutaneous approach to venous revascularization has gained popularity. This method reduces patient exposure to more invasive therapies. In this case series, we describe two cases of a total venous occlusion that were successfully revascularized using a "wire externalization" technique. This technique requires the use of antegrade and retrograde access.

Keywords: Externalization technique; Total venous occlusion; Venoplasty.

Fig. 1

A. Pig tail catheter in the SVC(solid arrow) and multipurpose guide catheter in the left subclavian vein (dashed arrow) with simultaneous contrast injection showing a long venous occlusion B. Confianza PRO 12 wire (solid arrow) entering the true lumen of the SVC C. R350 externalization wire being snared (solid arrow) D. Snared R350 wire being pulled into the guide catheter E. Retrograde noncompliant balloon (solid arrow) dilation of the stenotic vein F. Pacemaker lead (solid arrow) being advanced through a SafeSheath.

Fig. 2

A. Proximal site to subclavian stenosis (solid arrow) and distal cap of stenotic lesion (dashed arrow) seen with bilateral contrast injection B. Confianza PRO 12 wire (dashed arrow) entering the true lumen of the innominate vein, JR4 guide (solid arrow) C. Uninflated compliant balloon (solid arrow) D. Inflated 5 × 20 mm non-compliant balloon crossing the stenotic lesion E. Contrast injection in the cannulated coronary sinus F. Lateral cardiac vein cannulated using LV lead (Solid arrow).