Subclavian venoplasty for device implantation in a district general hospital: a case series.

Subclavian venoplasty is commonly performed for subclavian vein stenosis in patients with long-term dialysis lines or fistulae. Such stenosis may also occur in patients with previously implanted intra-cardiac devices. It poses a problem if a further device upgrade or implantation is planned as the stenosis restricts the advancement of leads. Venoplasty before device implantation may provide a feasible alternative to lead tunnelling or extraction, which have their limitations. Four cases of varying complexities and devices that were implanted in patients with subclavian stenosis are presented herein. These were done in a district general hospital within the cardiology team. Venoplasty was performed using peripheral angioplasty balloons after which the device was implanted. All cases were performed successfully without any immediate complications with the patients discharged home the same day. These cases show the utility of subclavian venoplasty in facilitating device implantation without the need to utilise contralateral venous access, hence preserving venous access for the future. Additionally, they illustrate that this may be performed locally in a district general hospital setting, where appropriate expertise is available, with a high success rate and without the need to refer patients to an alternate tertiary care institute which may be associated with additional difficulties for the patient. To the best of our knowledge, this is the first instance where several cases of this procedure were performed successfully in a secondary care setting.