Pacemaker lead placement via a small cephalic vein

The development of implantable defibrillators with single lead systems has necessitated the need for larger transvenous electrodes. This article describes a modified Seldinger technique that can be used when the cephalic vein is too small to allow passage of these larger leads. When successful, the procedure eliminates the need for direct needle cannulation of the subclavian vein and the accompanying risk of pneumothorax.