Double target method (double marker-guided extrathoracic introducer insertion).

Incidence of damage to pacemaker and implantable cardioverter defibrillator leads is an emerging problem that should be prevented. The extrathoracic venipuncture approach has been suggested as a technique for venous access to avoid the problem. This report describes the method of double marker-guided venipuncture of extrathoracic subclavian and/or axillary vein. This approach achieves definite, safe, and speedy extrathoracic venipuncture and may be especially suitable for multiple lead placement for cardiac resynchronization therapy.