Abstract 15458: Inside-out Access: A New Method of Lead Placement for Patients with Central Venous Occlusions
Objective: We describe a new method of vascular access that allows pre-pectoral placement of conventional pacing and defibrillation leads in patients with complex central venous occlusions that cannot be recanalized using currently available methods.
Methods: Seven patients with central venous occlusions were referred for device implantation. Inside-out central venous access (IOCVA) was obtained via the percutaneous femoral approach. A catheter-dilator system was advanced across the right atrium, to the most central point of venous occlusion. The occluded vein was punctured with a directional needle and a catheter was advanced along intravascular or extravascular tissue planes to the subclavian region. A solid wire needle was then oriented toward the skin surface and advanced through the soft tissues until exit from the body. The wire was utilized to pull rigid dilators through the occluded segment. Conventional transvenous leads were implanted though the new channel.
Results: All patients had chronic, total venous occlusions that were inaccessible by conventional methods (3 superior vena cava, 4 brachiocephalic and bilateral subclavian). All patients had successful, pre-pectoral device implants (3 right-sided, 4 left-sided; 1 single-chamber, 3 dual-chamber, 3 biventricular). There were no procedure-related complications. All patients had normal lead parameters and device function at follow-up of 170 +/− 378 days.
Conclusions: Physicians will increasingly encounter patients who require rhythm management devices but have venous obstructions that prevent conventional access. For those patients, IOCVA appears to be a safe and effective approach to device placement. Furthermore, IOCVA overcomes the limitations of transiliac and thoracotomy based procedures.
- Implantable cardioconvert defibrillator
- Vascular disease
- Complete total occlusion
- © 2010 by American Heart Association, Inc.