Use of a laser sheath to obtain venous access in pacemaker lead-related obstruction without extraction of the lead.
OBJECTIVE
Occlusion of the subclavian vein resulting from pacemaker leads prohibits insertion of new leads. We describe the ipsilateral insertion of a new lead without extracting the old lead using a laser sheath in a pacemaker patient with an obstructed vein.


RESULTS
A laser sheath together with an outer sheath were advanced over the malfunctioning lead just beyond the occlusion. The laser sheath was pulled back and a guide wire inserted through the outer sheath kept in position distal of the occlusion. After removal of the outer sheath a peel-away sheath was introduced and a new lead implanted next to the malfunctioning lead that was abandoned and not extracted.


CONCLUSIONS
By avoiding using the laser along the whole length of the lead we greatly reduced the risk of the procedure but were still able to recanalize the obstructed vein. A risk of bilateral occlusion is avoided and the contralateral site saved as an entry point for future needs.
Bracke
F A L E
FA
Department of Cardiology, Catharina Hospital, Eindhoven, The Netherlands. f.bracke@skynet.be
Meijer
A
A
van Gelder
L M
LM
D001145:Arrhythmias, Cardiac / Q000000981:diagnostic imaging / Q000628:therapy*; D004868:Equipment Failure; D006083:Graft Occlusion, Vascular / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery*; D006801:Humans; D053685:Laser Therapy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial / Q000009:adverse effects*; D010690:Phlebography; D013350:Subclavian Vein / Q000000981:diagnostic imaging / Q000601:surgery*