With expanding indications for cardiac resynchronization therapy and increased survival of patients with cardiovascular disease, the need for lead addition or revision in the presence of an existing implantable electronic device is likely to increase. Partial or complete venous occlusion is frequently encountered and can be a significant barrier to successful procedural outcomes. Percutaneous options, including subclavian venoplasty, can reduce the need for significantly more invasive and morbid procedures and can readily be learned by the implanting physician. Additional invasive techniques, such as coronary sinus venoplasty and stenting, can be useful in cases of difficult left ventricular lead placement.