Transiliac Vein Approach to a Permanent Pacemaker Implantation After Aortic Valve Reoperation

Abstract

This article describes the case of a 71-year-old woman in whom a permanent pacemaker implantation was performed through an iliac vein because of superior vena cava obstruction after aortic valve reoperation. During a 6-month follow-up, the patient did well and the pacemaker performance was satisfactory.

Permanent pacemaker lead implantation via azygous vein in a patient with silent superior vena cava syndrome

“…Barakat et al, reported transfemoral pacemaker implantation in three patients in whom pacing via the superior vena cava was not possible or suboptimal [4]. Goto et al, reported transiliac vein approach to a permanent pacemaker implantation, because of superior vena cava obstruction after aortic valve reoperation [5]. Erdogan et al used also transiliac approach in patients who underwent lead extraction for infected pectoral pacemaker systems [6].…”

Permanent Pacemaker Implantation via the Iliac Vein: An Alternative in 4 Cases with Contraindications to the Pectoral Approach

“…However, many authors who have described the iliac vein approach expressed concerns about the relation between lead fracture and hip joint movement. 2,4,8,9) It is uncertain whether this complication rate is higher than that for the pectoral approach. Further research is needed to evaluate this complication via the iliac vein approach.…”

“…The incidence of atrial lead dislodgement using this approach has been reported to range from 7 to 21%. [2][3][4][5] When an atrial lead is implanted using the iliac vein approach, due to anatomical morphology where the atrial lead runs from the external iliac vein to the right atrium via the inferior vena cava, the tip of the implanted atrial lead has to continuously bear its own weight. This gravitydependent force continuously acts on the tip of the implanted atrial lead to withdraw it from the site where it is fixed to the right atrial wall.…”

“…Clinically, 1-6% of patients who require permanent pacemaker implantation have features that make the conventional pectoral approach not possible or contraindicated due to various reasons, including anatomical anomalies, acquired subclavian vein or SVC occlusion, repeated attempts at SVC lead implantation, and inability to place a subdermal pouch on the anterior chest wall due to thin skin. [2][3][4][5][6][7][8][9] The insertion of a permanent pacemaker in patients with these complications poses the practical problem of how to gain access to the heart. Though implantation of transvenous pacing leads via the iliac vein is considered an effective alternative procedure in such patients, the iliac vein approach is currently performed in a limited number of institutions.…”

“…Though implantation of transvenous pacing leads via the iliac vein is considered an effective alternative procedure in such patients, the iliac vein approach is currently performed in a limited number of institutions. [2][3][4][5][6][7][8][9] The underutilization of the iliac vein approach may be due to the fear of possible complications associated with this approach, including lead dislodgement, lead fracture, infection, and retroperitoneal hematoma. [2][3][4][5][6][7][8][9] Lead dislodgement, especially the atrial lead has been considered the major complication associated with this procedure.…”