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Case Reports
. 2019 Oct 8:20:1482-1486.
doi: 10.12659/AJCR.916576.

Unusual Venous Access for Device Implantation

Mohammed Al-Sadawi  1 , Adam S Budzikowski  2
Affiliations
Case Reports

Unusual Venous Access for Device Implantation

Mohammed Al-Sadawi et al. Am J Case Rep. .

Abstract

BACKGROUND Cardiac implantable electronic devices (CIED) are mainstay therapy for a variety of patients with bradyarrhythmia as well as those at risk of sudden cardiac death and heart failure. At present, commonly used venous access are axillary, cephalic cutdown, and subclavian puncture. However, there are situations when these approaches cannot be employed because cannulation is not possible due to small size, spasm, absence, or occlusion of the vein. One of the alternative approaches is through an internal or external jugular vein. A jugular vein approach can be also used for upgrading CIED knowing that CIED is not commonly associated with venous occlusion. CASE REPORT We present 3 cases which used unusual venous access for placement of CIED using a jugular vein approach. CONCLUSIONS Recognizing patients who have difficult venous access for CIED and using alternative approaches, like a jugular vein approach, for device insertion is important to avoid unnecessary medical and technical complications.

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Conflict of interest statement

Conflict of interest: None declared

Figures

Figure 1.
Figure 1.
Case 1: (A) Venography of the right upper extremity showing total occlusion of subclavian vein. (B) Chest x-ray posteroanterior (PA) view: Biventricular pacemaker placed via right external jugular vein with right ventricle (RV) and coronary sinus (CS) leads tunneled to the left subclavian pocket.
Figure 2.
Figure 2.
Case 2: (A) Dual chamber ICD before the upgrade; (B, C) Chest x-ray posteroanterior (PA) and lateral view; biventricular ICD in place with the left ventricular lead inserted via right internal jugular vein.
Figure 3.
Figure 3.
Case 3: (A) Venography of right upper extremity showing severe stenosis of the right and left subclavian veins. Note portacath access port present on the left. (B) Repeat venography revealed total occlusion of the subclavian veins. (C) Chest x-ray posteroanterior (PA) view: biventricular defibrillator placed via right internal jugular vein with right atrial (RA) and coronary sinus (CS) leads.
See this image and copyright information in PMC

References

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