RESUMO
A 56-year-old man was admitted for pacemaker generator replacement. We identified a partial fracture in the proximal part of the lead just after the conjunction of the atrial and ventricular leads. The atrial lead sensitivity was stable even under intentional pulling and twisting. We deployed a splint made of a suture-sleeve in the fracture site. After burying the malfunctioning ventricular connector behind the pocket, we inserted only a new ventricular lead. However, another complication existed. Venogram showed a total occlusion between the brachiocephalic vein and superior vena cava. After meticulous wiring, we passed the target and dilated the vessel with 8 and 9 Fr dilators. Finally, a new ventricular lead and generator were inserted via a long peel-away sheath. In conclusion, we successfully treated a patient with a partial lead fracture and a brachiocephalic vein occlusion using splinting and venoplasty.