A Novel Approach to ICD Lead Revision in a Patient with Extensive Vascular Thrombosis

Chronic extensive thrombosis of the venous system is a commonly encountered problem in end stage renal disease (ESRD) patients undergoing transvenous device implantation, lead extraction or lead revision. We describe a case of an ESRD patient with an implantable cardioverter defibrillator (ICD) that failed to deliver therapy due to lead fracture. Patient needed revision of the ICD lead system, but had extensive axillary-subclavian-superior vena cava occlusion. Patient refused a thoracotomy approach as well as lead extraction as he had a complicated course of lead extraction in the past. We successfully improvised a novel technique to revise the ICD system.