Lead insertion by supraclavicular approach of the subclavian vein puncture

Total occlusion of the left subclavian vein was diagnosed in a 76-year-old patient, 6 years after implantation of an ICD with VVI pacing backup. Repla cement of the ICD included upgrading of the ICD system because of the prese nce of pacemaker syndrome when he patient was WI paced. Insertion of an atr ial lead through the ipsilateral vein system was made possible by using the supraclavicular approach of the subclavian, enabling puncturing of the lef t subclavian vein medially to the obstruction.