Contralateral venous access

Occasionally, the vessel to be recanalized is thrombosed or obstructed, precluding venous access on the same side. In this case, contralateral venous access should be considered (87). In this instance, the desired electrode is passed via the contralateral subclavian vein, positioned, and subsequently tunneled back to the original pocket (Fig. 4.30). The contralateral puncture site requires a limited skin incision of about 1-2 cm. It is carried down to the surface of the pectoralis muscle. The pectoralis muscle is used for anchoring the electrode with its suture sleeve. The electrode is anchored and secured ouce it has been positioned. The proximal end of the electrode is then tunneled back to the original pocket... 

Lead removal is reasonable in patients with ipsilateral venous occlusion preventing access to the venous circulation for required placement of an additional lead, when there is no contraindication for using the contralateral side... 

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