Percutaneous electrosurgical technique for treatment of subclavian vein occlusion: Application of transcaval techniques Jason R. Foerst, MD, David Kim,

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Presentation transcript:

Percutaneous electrosurgical technique for treatment of subclavian vein occlusion: Application of transcaval techniques Jason R. Foerst, MD, David Kim, MD, Terrence P. May, MD HeartRhythm Case Reports Volume 3, Issue 11, Pages 551-554 (November 2017) DOI: 10.1016/j.hrcr.2017.08.006 Copyright © 2017 Heart Rhythm Society Terms and Conditions

Figure 1 Percutaneous electrosurgical technique for crossing the subclavian vein chronic total occlusion. An Astato XS 20 0.014-in (Asahi, Aichi, Japan) wire is inserted through a 4F angled glide wire to the occlusion; it is important to be sure only the tip of the wire is exposed (white arrow). In preparation it is imperative to clamp the electrosurgical pencil to the proximal-most end of the wire (red circle) and keep all metal and wet gauze off the wire to prevent dispersion of charge. The wire is advanced while applying 30–50 W of “cut” energy. HeartRhythm Case Reports 2017 3, 551-554DOI: (10.1016/j.hrcr.2017.08.006) Copyright © 2017 Heart Rhythm Society Terms and Conditions

Figure 2 Case 1. A: Chronic total occlusion (white bars) of the left subclavian vein at pacemaker lead site with prominent collaterals. B: Astato XS 20 wire advanced across occlusion angled along the existing leads. C: Glide catheter advanced across lesion with contrast injection confirming flow into superior vena cava. D: Venoplasty (white arrow) of the subclavian vein occlusion over a Worley wire directed into the inferior vena cava. E: Easy traversal of sheath, allowing coronary sinus access and coronary sinus lead implant. HeartRhythm Case Reports 2017 3, 551-554DOI: (10.1016/j.hrcr.2017.08.006) Copyright © 2017 Heart Rhythm Society Terms and Conditions

Figure 3 Case 2. A: Chronic total occlusion (white bars) of the left subclavian vein at pacemaker lead site with a prominent collateral. B: Balloon venoplasty (white arrow) following percutaneous electrosurgical traversal of the chronic total occlusion using the existing pacemaker leads to guide the wire trajectory (white dotted lines). C: Easy traversal of sheath, allowing coronary sinus (CS) access and subsequent CS lead implant. HeartRhythm Case Reports 2017 3, 551-554DOI: (10.1016/j.hrcr.2017.08.006) Copyright © 2017 Heart Rhythm Society Terms and Conditions