Over the wire lead extraction and focused force venoplasty to regain venous access in a totally occluded subclavian vein.
BACKGROUND
Venoplasty allows the addition or replacement of leads despite subtotal or total subclavian occlusion.


METHODS
The threshold of the LV pacing lead implanted for biventricular pacing over a period of 18 months increased to greater than 5 V. A pre implant venogram revealed total subclavian occlusion. Venous access was maintained by extraction of the 4 F LV lead over a wire. Subsequently the sheath would not advance despite 6mm balloon inflation to 30 atm with no residual waist. A wire was placed beside the balloon and the balloon was reinflated.


RESULTS
The subclavian obstruction was eliminated without damage to the existing leads.


CONCLUSIONS
The obstruction formed by the fibrous track around an extracted lead may persist despite what appears to be successful balloon dilation. Inflation with a wire beside the balloon increases the effect eliminating the resistant obstruction without damaging the leads.
Heart Center, Lancaster General Hospital, Lancaster, PA, USA, seth@mcworley.com
Seth J
SJ
Worley
Douglas C
DC
Gohn
Robert W
RW
Pulliam
D002404:Catheterization; D020878:Device Removal; D004567:Electrodes, Implanted; D004868:Equipment Failure; D006801:Humans; D010138:Pacemaker, Artificial / Q000009:adverse effects*; D011859:Radiography; D013350:Subclavian Vein / Q000000981:diagnostic imaging* / Q000601:surgery*; D020246:Venous Thrombosis / Q000000981:diagnostic imaging* / Q000601:surgery*