title: Needle directed re-entry to cross a subclavian occlusion following failed microdissection.
abstract: Patients with existing internal cardioverter defibrillators (ICDs) often require upgrading to a biventricular ICD for treatment of congestive heart failure. Placement of a left ventricular (LV) lead can be technically challenging in the best of circumstances. A subclavian vein stenosis or occlusion related to previously placed leads adds a major obstacle to a successful implant. We report a technique to implant an LV lead from the same side as the existing ICD system despite failed microdissection of a complete occlusion of the subclavian vein.
authors: Lancaster Heart and Stroke Foundation, Lancaster General Hospital, Lancaster, PA, USA. seth@mcworley.com
authors: Seth Joseph
authors: SJ
authors: Worley
authors: Douglas Charles
authors: DC
authors: Gohn
authors: Robert Ward
authors: RW
authors: Pulliam
mesh_terms: D000368:Aged; D017147:Defibrillators, Implantable; D004567:Electrodes, Implanted; D004867:Equipment Design; D005471:Fluoroscopy; D006333:Heart Failure / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D008297:Male; D009339:Needles; D010690:Phlebography; D013350:Subclavian Vein