Introduction of permanent cardiac stimulation/defibrillation leads via the retro-pectoral veins.

When the cephalic vein route is not easily accessible for the introduction of permanent stimulation/defibrillation leads, retro-pectoral veins can be looked for, which are usually present and suitable in most patients. As with the cephalic vein route, it is a safer approach than direct subclavian vein puncture. Moreover, using a guidewire and a split introducer increases the rate of successful cannulation.