Transvenous lead implantation via the accessory hemiazygos vein in superior vena cava occlusion

Key Findings▪Lead delivery via the persistent left superior vena cava (SVC) and collateralized accessory hemiazygos vein was feasible in the context of right SVC occlusion.▪This transvenous approach was challenging owing to venous tortuosity but avoided more invasive approaches, including cardiac surgical lead placement and vascular intervention.▪Computed tomography venography and venous angiography were key to the planning of this procedure.▪Lead delivery via collateralized venous systems may be feasible in selected cases of central venous stenosis or occlusion. ▪Lead delivery via the persistent left superior vena cava (SVC) and collateralized accessory hemiazygos vein was feasible in the context of right SVC occlusion.▪This transvenous approach was challenging owing to venous tortuosity but avoided more invasive approaches, including cardiac surgical lead placement and vascular intervention.▪Computed tomography venography and venous angiography were key to the planning of this procedure.▪Lead delivery via collateralized venous systems may be feasible in selected cases of central venous stenosis or occlusion.