Left Subclavian and Innominate Vein Balloon Venoplasty Followed by Permanent Pacemaker Implantation: A Case Report

Upper-extremity venous obstruction is not an uncommon problem encountered by electrophysiologists. The placement of any catheter including pacemaker leads can cause stenosis or total obstruction. Affected patients often require balloon venoplasty to facilitate lead implantation. If the vein is unresponsive to venoplasty, stenting of the vein should be contemplated. We report a case of permanent pacemaker implantation after balloon venoplasty of the left subclavian vein and innominate vein following total occlusion in a patient with symptomatic complete heart block. There are many case reports to date in which balloon venoplasty of the subclavian vein has been performed before upgrading a single-chamber pacemaker to a DDD-mode pacemaker, cardiac resynchronization therapy device, or implantable cardioverter-defibrillator because of chronic venous occlusion secondary to a preexisting pacing lead. Balloon venoplasty to increase the diameter of a target vein or to overcome stenosis may be a technique that implanting electrophysiologists could adopt in order to achieve success in patients with more challenging anatomies.