title: Transhepatic venous approach to permanent pacemaker placement in a patient with limited central venous access.
abstract: The end-stage renal disease population poses a challenge for obtaining venous access required for life-saving invasive cardiac procedures. In this case report, we describe an adult patient with end-stage renal disease in whom the hepatic vein was the only available access to implant a single-lead permanent cardiac pacemaker. A 63-year-old male with end-stage renal disease on maintenance hemodialysis and permanent atrial fibrillation/atrial flutter presented with symptomatic bradycardia. Imaging studies revealed all traditional central venous access sites to be occluded/non-accessible. With the assistance of vascular interventional radiology, a trans-hepatic venous catheter was placed. This was then used to place a right ventricular pacing lead with close attention to numerous technical aspects. The procedure was completed successfully with placement of a single-lead permanent cardiac pacemaker.
authors.affiliation: Adeel M Siddiqui, Department of Internal Medicine, East Carolina School of Medicine, Greenville, NC 27834, United States.
authors.forename: Adeel M
authors.initials: AM
authors.lastname: Siddiqui
authors.affiliation: Adeel M Siddiqui, Department of Internal Medicine, East Carolina School of Medicine, Greenville, NC 27834, United States.
authors.forename: Gregory S
authors.initials: GS
authors.lastname: Harris
authors.affiliation: Adeel M Siddiqui, Department of Internal Medicine, East Carolina School of Medicine, Greenville, NC 27834, United States.
authors.forename: Assad
authors.initials: A
authors.lastname: Movahed
authors.affiliation: Adeel M Siddiqui, Department of Internal Medicine, East Carolina School of Medicine, Greenville, NC 27834, United States.
authors.forename: Karl S
authors.initials: KS
authors.lastname: Chiang
authors.affiliation: Adeel M Siddiqui, Department of Internal Medicine, East Carolina School of Medicine, Greenville, NC 27834, United States.
authors.forename: Mihail G
authors.initials: MG
authors.lastname: Chelu
authors.affiliation: Adeel M Siddiqui, Department of Internal Medicine, East Carolina School of Medicine, Greenville, NC 27834, United States.
authors.forename: Rajasekhar
authors.initials: R
authors.lastname: Nekkanti
keywords: End-stage renal disease; Permanent cardiac pacemaker; Trans-hepatic venous access