title: Endovascular recanalization of central venous access to allow for pacemaker implantation or upgrade.
abstract: BACKGROUND
  Several patients undergoing permanent pacemaker (PPM) implantation/upgrade present with difficult access due to sub- or total central vein occlusion. Our institution has used the endovascular approach to recanalize central veins to allow for subsequent PPM implantation. Here we aim to describe the feasibility and safety of using this approach to allow for PPM implantation/upgrade.
  
  
  METHODS
  From October 2006 to November 2010, 50 consecutive patients who underwent central vein recanalization prior to PPM implantation were included in this analysis.
  
  
  RESULTS
  The population's mean age was 70 years, with a high rate of comorbidities including chronic renal failure (52.0%), congestive heart failure (64.0%), diabetes (33.3%) and peripheral vascular disease (36.0%). The endovascular recanalization procedure was performed via femoral access in all patients; however adjuvant brachial access was required in 13 cases and subclavian vein in one. Subclavian vein (74.5%) followed by innominate vein (21.6%) were the most common locations/target for recanalization. Successful vein recanalization followed by successful PPM implantation/upgrade was achieved in 48 patients (96.0%) without peri-procedural complications. Two patients died during the hospitalization, one due to severe respiratory failure and a second due to complicated end-stage renal disease, although neither was related to the endovascular procedure. No other event, including myocardial infarction, cerebral-vascular accident, bleeding/transfusion, or renal failure was identified.
  
  
  CONCLUSIONS
  This study proved the feasibility and safety of the endovascular approach to recanalize central veins in patients with poor vascular access to allow for further PPM implantation/upgrade.
authors: Washington Hospital Centeriding, 110 Irving Street, NW Suite 4B-1, Washington, DC 20010, USA.
authors: Gabriel
authors: G
authors: Maluenda
authors: Francis
authors: F
authors: Bustos
authors: Federico
authors: F
authors: Viganego
authors: Itsik
authors: I
authors: Ben-Dor
authors: Nicholas N
authors: NN
authors: Hanna
authors: Rebecca
authors: R
authors: Torguson
authors: William O
authors: WO
authors: Suddath
authors: Lowell F
authors: LF
authors: Satler
authors: Kenneth M
authors: KM
authors: Kent
authors: Augusto D
authors: AD
authors: Pichard
authors: Ron
authors: R
authors: Waksman
authors: Nelson L
authors: NL
authors: Bernardo
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000401:mortality; D015897:Comorbidity; D003251:Constriction, Pathologic; D004219:District of Columbia; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods / Q000401:mortality; D004867:Equipment Design; D005240:Feasibility Studies; D005260:Female; D005268:Femoral Vein / Q000000981:diagnostic imaging; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial / Q000009:adverse effects; D010690:Phlebography; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D015607:Stents; D016896:Treatment Outcome; D014652:Vascular Diseases / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*