Transhepatic venous approach to permanent pacemaker placement in a patient with limited central venous access

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.

Keywords: Trans-hepatic venous access; Permanent cardiac pacemaker; End-stage renal disease

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.