Unusual Venous Access for Device Implantation

Case series Patient: Male, 80 • Female, 67 • Male, 48 Final Diagnosis: Management of difficult venous access for implantable cardiac devices Symptoms: Heart failure Medication: — Clinical Procedure: — Specialty: Cardiology OBJECTIVE: Unusual clinical course BACKGROUND: Cardiac implantable electronic devices (CIED) are mainstay therapy for a variety of patients with bradyarrhythmia as well as those at risk of sudden cardiac death and heart failure. At present, commonly used venous access are axillary, cephalic cutdown, and subclavian puncture. However, there are situations when these approaches cannot be employed because cannulation is not possible due to small size, spasm, absence, or occlusion of the vein. One of the alternative approaches is through an internal or external jugular vein. A jugular vein approach can be also used for upgrading CIED knowing that CIED is not commonly associated with venous occlusion. CASE REPORT: We present 3 cases which used unusual venous access for placement of CIED using a jugular vein approach. CONCLUSIONS: Recognizing patients who have difficult venous access for CIED and using alternative approaches, like a jugular vein approach, for device insertion is important to avoid unnecessary medical and technical complications.