We report the outcome of the iliac vein approach for permanent pacemaker implantation in 4 patients in whom the conventional pectoral approach was not possible. The reasons for using the iliac vein approach were: recurrent lead infections at bilateral pectoral positions in 1 patient; superior vena cava obstruction following cardiac surgery in 2 patients; and a postoperative dermal scar due to right radical mastectomy secondary to a persistent left superior vena cava with absence of the innominate vein in 1 patient. This technique was safe and effective during the mean follow-up period of 24.3 months. At the latest follow-up, no patients showed signs of electrophysiological abnormalities. No short- or long-term complications were seen. Conclusions: The iliac vein approach is a less invasive and more feasible alternative without any complications for patients in whom the pectoral approach cannot be used.
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