Yamaguchi Tetsuo, Miyamoto Takamichi, Yamauchi Yasuteru, Obayashi Tohru
Department of Cardiology, Japanese Red Cross Musashino Hospital, 1-26-1, Kyonancho, Musashino City, Tokyo 180-8610, Japan.
J Arrhythm. 2016 Apr;32(2):151-3. doi: 10.1016/j.joa.2015.08.004. Epub 2015 Nov 11.
An 85-year-old man was referred to our hospital with a pacemaker pocket infection. A permanent pacemaker had been implanted via the right subclavian vein. The pacemaker and pacing leads were removed and a temporary pacemaker was implanted. After vancomycin treatment for 4 weeks, pacemaker implantation via the right external iliac vein was performed under local anesthesia because of left subclavian vein occlusion, infection of the right pocket, and difficulty with epicardial lead insertion. The iliac vein approach is an effective alternative in patients in whom the pectoral approach cannot be used.
Permanent pacemaker implantation using the conventional pectoral approach is impossible or contraindicated in 1-6% of patients. In such patients, implantation via the iliac vein is considered an effective alternative. The advantages of this approach are that the wound size and bleeding amount are very small and that it can be performed under local anesthesia. Therefore, this approach can be used in patients with a poor general condition, including elderly patients.
一名85岁男性因起搏器囊袋感染被转诊至我院。其永久性起搏器通过右锁骨下静脉植入。移除了起搏器及起搏导线，并植入了临时起搏器。在接受万古霉素治疗4周后，由于左锁骨下静脉闭塞、右囊袋感染以及心外膜导线插入困难，在局部麻醉下经右髂外静脉进行了起搏器植入。对于无法采用胸壁入路的患者，髂静脉入路是一种有效的替代方法。
在1%至6%的患者中，采用传统胸壁入路进行永久性起搏器植入是不可能的或禁忌的。在此类患者中，经髂静脉植入被认为是一种有效的替代方法。该方法的优点是伤口大小和出血量非常小，且可在局部麻醉下进行。因此，该方法可用于包括老年患者在内的一般状况较差的患者。
