Transvenous Placement of a Pacemaker Lead Through an Introducer Despite Long-standing Subclavian-Vein Occlusion

Under ordinary circumstances complete chronic subclavian vein occlusion precludes using that vein for the pacemaker lead. There are circumstances, however, in which a patent vein beyond the obstruction can be reached with an introducer needle, thus permitting transvenous access similar to any other introducer-assisted implantation. A case exemplifying this point is described. Patency of the right subclavian vein beyond an occlusion was demonstrated by angiography, and a new dual-chamber pacemaker lead was inserted through that site by use of the introducer method.