Siddiqui AM, Harris GS, Movahed A, Chiang KS, Chelu MG, Nekkanti R. Transhepatic venous approach to permanent pacemaker placement in a patient with limited central venous access. World J Clin Cases 2015; 3(9): 835-837 [PMID: 26380831 DOI: 10.12998/wjcc.v3.i9.835]
Corresponding Author of This Article
Adeel M Siddiqui, MD, Department of Internal Medicine, East Carolina School of Medicine, 115 Heart Drive, Greenville, NC 27834, United States. siddiquia@ecu.edu
Research Domain of This Article
Cardiac & Cardiovascular Systems
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
Share the Article
Siddiqui AM, Harris GS, Movahed A, Chiang KS, Chelu MG, Nekkanti R. Transhepatic venous approach to permanent pacemaker placement in a patient with limited central venous access. World J Clin Cases 2015; 3(9): 835-837 [PMID: 26380831 DOI: 10.12998/wjcc.v3.i9.835]
World J Clin Cases. Sep 16, 2015; 3(9): 835-837 Published online Sep 16, 2015. doi: 10.12998/wjcc.v3.i9.835
Transhepatic venous approach to permanent pacemaker placement in a patient with limited central venous access
Adeel M Siddiqui, Gregory S Harris, Assad Movahed, Karl S Chiang, Mihail G Chelu, Rajasekhar Nekkanti
Adeel M Siddiqui, Department of Internal Medicine, East Carolina School of Medicine, Greenville, NC 27834, United States
Gregory S Harris, Assad Movahed, Mihail G Chelu, Rajasekhar Nekkanti, Department of Cardiovascular Sciences, East Carolina Brody School of Medicine, Greenville, NC 27834, United States
Karl S Chiang, Vascular Interventional Radiology, Vidant Medical Center, Greenville, NC 27834, United States
Author contributions: Siddiqui AM, Harris GS and Movahed A designed the report; Chelu MG, Chiang KS and Nekkanti R performed the procedure.
Institutional review board statement: Please note that case reports consisting of less than three cases are not required to undergo the IRB approval process at our institution (East Carolina University).
Informed consent statement: Please note that case reports consisting of one case are not required to undergo the informed consent statement process at our institution (East Carolina University).
Conflict-of-interest statement: None of the authors have any disclosures.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Adeel M Siddiqui, MD, Department of Internal Medicine, East Carolina School of Medicine, 115 Heart Drive, Greenville, NC 27834, United States. siddiquia@ecu.edu
Telephone: +1-252-7443597 Fax: +1-252-7443987
Received: March 10, 2015 Peer-review started: March 12, 2015 First decision: April 27, 2015 Revised: May 15, 2015 Accepted: June 15, 2015 Article in press: June 16, 2015 Published online: September 16, 2015 Processing time: 189 Days and 7.5 Hours
Abstract
The end-stage renal disease population poses a challenge for obtaining venous access required for life-saving invasive cardiac procedures. In this case report, we describe an adult patient with end-stage renal disease in whom the hepatic vein was the only available access to implant a single-lead permanent cardiac pacemaker. A 63-year-old male with end-stage renal disease on maintenance hemodialysis and permanent atrial fibrillation/atrial flutter presented with symptomatic bradycardia. Imaging studies revealed all traditional central venous access sites to be occluded/non-accessible. With the assistance of vascular interventional radiology, a trans-hepatic venous catheter was placed. This was then used to place a right ventricular pacing lead with close attention to numerous technical aspects. The procedure was completed successfully with placement of a single-lead permanent cardiac pacemaker.
Core tip: End-stage renal disease patients pose a great challenge to establish central venous access. In situations when life-saving cardiac procedures are required in such patients, the clinician must use non-traditional venous access sites to perform these procedures. In our case report, we illustrate the novel use of the trans-hepatic venous access route to implant a single-lead permanent cardiac pacemaker in a patient with bradycardia and hypotension. Additionally, we describe the technical challenges associated with this procedure.
