Pacemaker Lead Implantation Through an Unrecognized Right Subclavian Vein Occlusion: A Case Report

Central venous occlusion can pose significant challenges during transvenous pacemaker implantation. We report a case of successful pacemaker lead implantation through an unrecognized chronic right subclavian vein occlusion. A 77-year-old male on maintenance hemodialysis was referred for permanent pacemaker implantation due to symptomatic bradycardia. During the procedure, venous access was obtained via the right subclavian approach, and a guidewire was advanced toward the superior vena cava. Subsequent venography revealed chronic occlusion of the right subclavian vein with well-developed collateral circulation. Despite the occlusion, the guidewire traversed the obstructed segment smoothly, allowing successful advancement and positioning of the pacing lead in the right ventricle with stable electrical parameters. No vascular injury or immediate complications occurred. This case demonstrates that cautious guidewire traversal of chronic venous occlusion may allow standard transvenous lead implantation and help avoid more invasive alternatives in selected patients.