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/
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.
