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

World J Clin Cases. 2015 Sep 16;3(9):835-7. doi: 10.12998/wjcc.v3.i9.835.


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

Publication types

  • Case Reports