Supraclavicular vein approach for upgrading an implantable cardioverter defibrillator to a biventricular device.

Total occlusion of the left subclavian vein was found in a 52-year-old patient, 5 years after implantation of an implantable cardioverter defibrillator (ICD). During replacement, the ICD was upgraded to a biventricular device for worsening of the patient's congestive heart failure to New York Heart Association class III. Insertion of the left ventricular lead in the ipsilateral vein system was successfully achieved by using the supraclavicular approach, enabling puncturing of the left subclavian vein medially to the obstruction.