Iliac vein approach to permanent pacemaker implantation.

Since July 1980, 90 patients have had 95 permanent pacemakers implanted via an iliac vein approach. An incision is made superior to the inguinal ligament and the iliac vein is cannulated with a single lead for the ventricle or two leads for the atrium and ventricle. The pulse generator is placed in the subcutaneous tissue of the abdomen lateral to the umbilicus via a second incision. Overall 28 pacemaker implants were for atrial pacing, 53 for ventricular pacing and 14 were dual chamber. Nine (21%) of the atrial leads displaced and required repositioning and 5 (7%) of the ventricular leads dislodged and required revision. Lead dislodgement, especially in the atrium, remains a major weakness of the approach, and decreases its utility. Eleven percent of the last 19 atrial leads have dislodged. Nevertheless, the method is simple to perform and is presented as an alternative to the usual pectoral implantation site.