Learning objective: Permanent pacemaker implantation using the conventional pectoral approach is impossible or contraindicated in 1–6% of patients. In such patients, implantation via the iliac vein is considered an effective alternative. The advantages of this approach are that the wound size and bleeding amount are very small and that it can be performed under local anesthesia. Therefore, this approach can be used in patients with a poor general condition, including elderly patients.
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