Case repor t
A 54-year-old woman with history of complete heart block status post biventricular permanent pacemaker (BiV-PPM) implantation, three years prior, presented with persistent left arm pain and swelling that resulted in limitations of her daily activities. Physical examination revealed edema above the clavicle, the arm and the hand. The remainder of the physical examination was unremarkable. Subclavian venogram revealed total occlusion of her left subclavian vein. Recognizing the limitations of balloon dilation alone and the risk and uncertain results of lead extraction followed by stenting an alternative strategy was sought. Given the favorable results of adding a drug coated balloon to high pressure balloon dilation in patients with stenotic dialysis fistulas we decided to add the drug coted balloon to high pressure balloon dilation.