Open AccessTranshepatic venous approach to permanent pacemaker placement in a patient with limited central venous access
Author(s) -
Adeel Siddiqui,
Geoff Harris,
Assad Movahed,
Karl S. Chiang,
Mihail G. Chelu,
Rajasekhar Nekkanti
Publication year - 2015
Publication title -
world journal of clinical cases
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.368
H-Index - 10
ISSN - 2307-8960
DOI - 10.12998/wjcc.v3.i9.835
Subject(s) - medicine , permanent pacemaker , atrial fibrillation , atrial flutter , cardiology , bradycardia , hemodialysis , population , surgery , vein , heart rate , environmental health , blood pressure
The end-stage renal disease population poses a challenge for obtaining venous access required for life-saving invasive cardiac procedures. In this case report, we describe an adult patient with end-stage renal disease in whom the hepatic vein was the only available access to implant a single-lead permanent cardiac pacemaker. A 63-year-old male with end-stage renal disease on maintenance hemodialysis and permanent atrial fibrillation/atrial flutter presented with symptomatic bradycardia. Imaging studies revealed all traditional central venous access sites to be occluded/non-accessible. With the assistance of vascular interventional radiology, a trans-hepatic venous catheter was placed. This was then used to place a right ventricular pacing lead with close attention to numerous technical aspects. The procedure was completed successfully with placement of a single-lead permanent cardiac pacemaker.