[Permanent pacemaker lead insertion for totally occluded subclavian vein].

We experienced 4 patients with total occlusion of the subclavian vein in whom permanent pacemakers were implanted. Occlusion of the subclavian vein was not clinically apparent in these 4 patients. The pacing lead was inserted through the contralateral subclavian vein in a 65-year-old male. In a 80-year-old male, the pacing lead was inserted trough the internal jugular vein because of occlusion of both subclavian veins. The pacing lead was passed through the occluded portion of the innominate vein in a 84-year-old male. Phlebography-guided venipuncture was not difficult in a 79-year-old female whose mid-portion of the subclavian vein was occluded. All patients have done well since permanent pacemaker implantation. Preoperative phlebography should be performed as it may provide useful information concerning pathological alterations in the venous system that might hinder smooth implantation of the pacemaker. A review of the literature revealed no reports concerning methods in which pacing leads are passed through totally occluded portions of the subclavian vein. We here report 4 patients with total occlusion of the subclavian vein in whom permanent pacemakers were implanted via different venous routes.