Transvenous lead implantation via collateralized venous systems like the accessory hemiazygos vein is a feasible alternative to surgical placement in patients with central venous occlusion.
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May enable less invasive lead placement in right SVC occlusion; leaves open generalizability beyond this case.
Key Findings▪Lead delivery via the persistent left superior vena cava (SVC) and collateralized accessory hemiazygos vein was feasible in the context of right SVC occlusion.▪This transvenous approach was challenging owing to venous tortuosity but avoided more invasive approaches, including cardiac surgical lead placement and vascular intervention.▪Computed tomography venography and venous angiography were key to the planning of this procedure.▪Lead delivery via collateralized venous systems may be feasible in selected cases of central venous stenosis or occlusion. ▪Lead delivery via the persistent left superior vena cava (SVC) and collateralized accessory hemiazygos vein was feasible in the context of right SVC occlusion.▪This transvenous approach was challenging owing to venous tortuosity but avoided more invasive approaches, including cardiac surgical lead placement and vascular intervention.▪Computed tomography venography and venous angiography were key to the planning of this procedure.▪Lead delivery via collateralized venous systems may be feasible in selected cases of central venous stenosis or occlusion.
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Waddingham et al. (2021) studied this question.
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