Late perforation by pacemaker catheter loop in the neck: a preventable complication of the external jugular approach.

The external jugular vein is a less favored but still useful route for insertion of cardiac pacemaker catheters. When this approach is used, gradual descent of the pulse-generator in the subcutaneous tissue of the chest wall may produce sharp angulation of the catheter as it enters the vein. This may result, many months later, in pressure necrosis of the overlying skin. Techniques aimed at preventing such pulse-generator descent should obviate this complication.