Femoral approach: An exceptional alternative for permanent pacemaker implantation

Abstract

The classic transvenous implantation of a permanent pacemaker in a pectoral location may be precluded by obstruction of venous access through the superior vena cava or recent infection at the implant site. When these barriers to the procedure are bilateral and there are also contraindications or technical difficulties to performing a thoracotomy for an epicardial approach, the femoral vein, although rarely used, can be a viable alternative.We describe the case of a patient with occlusion of both subclavian veins and a high risk for mini-thoracotomy or videothoracoscopy, who underwent implantation of a permanent singlechamber pacemaker via the right femoral vein. © 2013 Sociedade Portuguesa de Cardiologia. Published by Elsevier España, S.L. All rights reserved. PALAVRAS-CHAVEPacing cardíaco definitivo; Obstrução acessos venosos; Radioterapia; Implantação via veia femoral Acesso femoral venoso: uma alternativa excecional para a implantação de pacemaker definitivo Resumo A implantação clássica de pacemaker definitivo (PMD) em posição antepeitoral e por via transvenosa pode ser impossibilitada por obstrução dos acessos venosos à veia cava superior ou pela presença de infeção recente no mesmo local. Quando estas barreiras são bilaterais e, concomitantemente, há contraindicação ou dificuldade técnica para uma abordagem por toracotomia para implantação de um eletrocateter epicárdico, a via femoral venosa, embora raramente utilizada, pode constituir uma alternativa viável.Descrevemos o caso de uma doente submetida a implantação de pacemaker definitivo monocamaral por via femoral direita por apresentar obstrução de ambos os acessos subclávios e ଝ Please cite this article as: Tereno Valente B, Conceição JM, Nogueira da Silva M, et al. Acesso femoral venoso: uma alternativa excecional para a implantação de pacemaker definitivo. Rev Port Cardiol. 2014;33:311.e1---311.e5.

Use of the transfemoral access approach for cardiac stimulation device implantation when the superior venous approach is not feasible: A single-centre twenty-year series

“…In addition, success with transfemoral access has been reported in problematic cases involving single-and dual-chamber pacemakers 10 , automatic implantable cardiac defibrillators (AICDs) using subcutaneous patches 11 , active-can 12 , CRT stimulation mode 13 , and even CRT mode using an endocardial electrode in the LV with transseptal access 7,9,14 . Nonetheless, the technique remains widely considered the very last resort 15 .…”

Strategy of pacemaker and electrode replacement for superior vena cava stenosis

“…Venous stenosis angioplasty is performed to expand a stenosed lumen during installation or replacement of a cardiac implant. 9 The femoral vein, 10–12 iliac vein, 13,14 and other vascular channels can be chosen to directly avoid the stenosis or absence of the SVC to complete the operation. However, angioplasty is difficult and risky.…”

Transfemoral access when superior venous approach is not feasible equals overall success of permanent pacemaker implantation. Ten‐year series

“…In addition, success with femoral access has been reported in problematic cases involving single‐ and dual‐chamber pacemakers, automatic implantable cardiac defibrillators (AICDs) using subcutaneous patches, active can, CRT stimulation mode, and even CRT mode using an endocardial electrode in the LV with transseptal access . Nonetheless, the technique remains widely considered as a very last resort …”