Open Access

Novel experience of laser-assisted ‘inside-out’ central venous access in a patient with bilateral subclavian vein occlusion requiring pacemaker implantation

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Date: 14 October 2016
Journal: EP Europace Journal , Volume 19 , Issue 10 , Pages 1750 - 1753
Authors: T. Aye , T. Phan , D. Muir , N. Linker , R. Hartley , A. Turley

ESC Journals

AbstractAim

This new laser facilitated ‘inside-out’ technique was used for transvenous pacemaker insertion in a pacemaker-dependent patient with bilateral subclavian occlusion and a failed epicardial system who is not suitable for a transfemoral approach.

Method and results

Procedure was undertaken under general anaesthesia with venous access obtained from right femoral vein and left axillary vein. 7F multipurpose catheter was used to enter proximal edge of the occluded segment of subclavian vein via femoral approach, which then supported stiff angioplasty wires and microcatheters to tunnel into the body of occlusion. When encountered with impenetrable resistance, 1.4 mm Excimer laser helped delivery of a Pilot 200 wire, which then progressed towards the distal edge of occlusion. Serial balloon dilatations allowed wire tracked into subintimal plane, advanced towards left clavicle using knuckle wire technique, which was then externalized with blunt dissection from infraclavicular pocket area. It was later changed to Amplatz superstiff wire exiting from both ends to form a rail, which ultimately allowed passage of pacing leads after serial balloon dilatation from clavicular end.

Conclusion

Our hybrid ‘inside-out’ technique permitted transvenous pacemaker insertion without complication and this is, to our knowledge, the first case using laser in this context.

About the contributors

Thandar Aye

Role: Author

Thanh Trung Phan

Role: Author

Douglas Findlay Muir

Role: Author