Pacemaker lead extraction and recapture of venous access: technical problems arising from extensive venous obstruction.

We report the case of the extraction of 18 year-old leads in a patient with a DDD pacemaker, and chronic obstruction of the left subclavian and innominate veins coexisting with extensive stenoses in the upper caval vein. After removal of pacing leads, angiographic guidewires were introduced via the Byrd dilatators and new pacing leads introduced with the use of long sheaths originally dedicated for transvenous left ventricular leads implantation. With this case, we discuss the problems arising during reimplantation of pacing leads in patients with chronic venous occlusion.