Percutaneous electrosurgical technique for treatment of subclavian vein occlusion: Application of transcaval techniques

Introduction Occlusion of the subclavian vein is a relatively common complication following permanent pacemaker implants, with an incidence of up to 10%. This rarely manifests clinically, but it becomes a problem when upgrading pacemakers with additional leads. As the population ages the need to reaccess the occluded veins for cardiac resynchronization therapy or defibrillator leads is increasing. These occlusions can be frequently crossed with hydrophilic wires; however, there is no standard for treatment of wire-resistant lesions. Many of these patients will undergo contralateral device implants and risky laser lead extractions or epicardial leads. We present a safe, novel strategy for crossing chronically occluded subclavian veins with existing pacemaker leads using an angled stiff-tipped 0.014-in wire charged with electrocautery, enabling successful coronary sinus lead implant.