Two Cases of Transhepatic Implantation of Cardiac Implantable Electronic Device: All Roads lead to Rome

Abstract

Lead insertion for cardiac implantable electronic devices requires venous access into the right side of the heart. The access route commonly used is from the axillary vein, through the subclavian vein and the superior vena cava. However, in patients with congenital heart malformations or those with vascular stenosis, and/or those who have undergone previous cardiac surgery, the passage of leads might be difficult, and the implantation procedure would show restricted scope. In such cases, insertion of leads through the hepatic vein is known to be a safe procedure. We report 2 cases of patients with limited vascular access who underwent lead implantation using the transhepatic approach-1 patient who underwent placement of an implantable cardioverter defibrillator and the other who underwent placement of a permanent pacemaker.