Subclavian vein percutaneous access

Fig. 4.30 A Pacemaker system upgrade using contralateral subclavian vein. The pacemaker pocket is opened and the old pulse generator and lead and dissected free, externalized and disconnected. B A second lead is inserted via the contralateral vein using the percutaneous technique. C The second lead is tunneled back to the initial pocket. The chronic ventricular and new atrial electrodes are connected to the pulse generator. (From Belott PH. Unusual access sites for Permanent Cardiac Pacing. In Barold SS, Mugica J, eds. Recent advances in cardiac pacing Goals for the 21st century. Armonk, NY Futura Publishing, 1997, with permission.)...

The standard site for the placement of a vena cava filter is below the renal veins in the IVC. However, due to sizing limitations or when there is a high risk of releasing emboli from the kidneys, vena cava filters can also be placed in the suprarenal position (Fig. 17.1). There are three approaches to their percutaneous insertion and delivery. Generally, noninvasive access through a femoral vein is most frequently used (82%),but alternatively, jugular,subclavian, and antecubital approaches have also been found to be clinically successful (Fig. 17.1). ... 

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