A case report of successful permanent pacemaker implantation via the iliac vein.
An 85-year-old man was referred to our hospital with a pacemaker pocket infection. A permanent pacemaker had been implanted via the right subclavian vein. The pacemaker and pacing leads were removed and a temporary pacemaker was implanted. After vancomycin treatment for 4 weeks, pacemaker implantation via the right external iliac vein was performed under local anesthesia because of left subclavian vein occlusion, infection of the right pocket, and difficulty with epicardial lead insertion. The iliac vein approach is an effective alternative in patients in whom the pectoral approach cannot be used.


OBJECTIVE
Permanent pacemaker implantation using the conventional pectoral approach is impossible or contraindicated in 1-6% of patients. In such patients, implantation via the iliac vein is considered an effective alternative. The advantages of this approach are that the wound size and bleeding amount are very small and that it can be performed under local anesthesia. Therefore, this approach can be used in patients with a poor general condition, including elderly patients.
Department of Cardiology, Japanese Red Cross Musashino Hospital, 1-26-1, Kyonancho, Musashino City, Tokyo 180-8610, Japan.
Tetsuo
T
Yamaguchi
Department of Cardiology, Japanese Red Cross Musashino Hospital, 1-26-1, Kyonancho, Musashino City, Tokyo 180-8610, Japan.
Takamichi
T
Miyamoto
Department of Cardiology, Japanese Red Cross Musashino Hospital, 1-26-1, Kyonancho, Musashino City, Tokyo 180-8610, Japan.
Yasuteru
Y
Yamauchi
Department of Cardiology, Japanese Red Cross Musashino Hospital, 1-26-1, Kyonancho, Musashino City, Tokyo 180-8610, Japan.
Tohru
T
Obayashi
Iliac vein; Local anesthesia; Permanent pacemaker implantation; Pocket infection; Subclavian vein occlusion