Usefulness of preoperative venography in patients with cardiac implantable electronic devices submitted to lead replacement or device upgrade procedures

Abstract

BackgroundVenous obstructions are common in patients with transvenous cardiac implantable electronic devices, but they rarely cause immediate clinical problems. The main consequence of these lesions is the difficulty in obtaining venous access for additional leads implantation.ObjectivesWe aimed to assess the prevalence and predictor factors of venous lesions in patients referred to lead reoperations, and to define the role of preoperative venography in the planning of these procedures.MethodsFrom April 2013 to July 2016, contrast venography was performed in 100 patients referred to device upgrade, revision and lead extraction. Venous lesions were classified as non-significant (< 50%), moderate stenosis (51-70%), severe stenosis (71-99%) or occlusion (100%). Collateral circulation was classified as absent, discrete, moderate or accentuated. The surgical strategy was defined according to the result of the preoperative venography. Univariate analysis was used to investigate predictor factors related to the occurrence of these lesions, with 5% of significance level.ResultsModerate venous stenosis was observed in 23%, severe in 13% and occlusions in 11%. There were no significant differences in relation to the device side or the venous segment. The usefulness of the preoperative venography to define the operative tactic was proven, and in 99% of the cases, the established surgical strategy could be performed according to plan.ConclusionsThe prevalence of venous obstruction is high in CIED recipients referred to reoperations. Venography is highly indicated as a preoperative examination for allowing the adequate surgical planning of procedures involving previous transvenous leads.

The Influence of Lead-Related Venous Obstruction on the Complexity and Outcomes of Transvenous Lead Extraction

“…Venous obstruction is a well-known complication after implantation of a permanent transvenous pacemaker. The incidence of venous obstruction reaches 30–45% with complete occlusion rates of 12% on average and 1–3% for symptomatic occlusion [ 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 ]. In the current study, severe venous obstruction was identified in 19.94% (40.77% if moderate occlusion was included) whereas complete occlusion in 22.34% of patients.…”

“…There are numerous reports on the estimation of the real risk of the TLE [ 26 , 27 , 28 , 29 ] but none of them considered LRVSO as a predictor of procedure difficulties. Among twenty reports on LRVSO [ 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 ], only three papers analyzed the occurrence of LRVSO before TLE [ 2 , 6 , 14 ], and only two considered the influence of LRVSO on procedure complexity providing at the same time conflicting results. Among 20 reports on LRVSO only two studies were carried out in populations over 200 patients [ 1 , 2 ], 10 in 100–150 participants [ 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 ] and the remaining eight studies in populations consisting of 30–89 patients [ 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 ].…”

Cardiac Implantable Electronic Devices in Hemodialysis and Chronic Kidney Disease Patients—An Experience-Based Narrative Review

“…As mentioned above, in non-dialysis patients, the insertion of transvenous lead(s) might result in central vein stenosis [8,9]. Central vein stenosis (CVS) is asymptomatic in most patients, but this is not the case in the HD population.…”

“…Transvenous CIED lead presence is associated with central vein stenosis. The frequency of severe stenosis or ipsilateral occlusion varies from 11 to 36% [8][9][10]. Therefore, when creating permanent vascular access, a clinical scenario may be complicated by CIED presence on one side and the lack of suitable vessels for arteriovenous fistula on the contralateral arm.…”

Efetividade e Segurança da Remoção de Cabos-Eletrodos Transvenosos de Marca-Passos e Desfibriladores Implantáveis no Cenário da Prática Clínica Real

“…A remoção de cabos-eletrodos de dispositivos cardíacos eletrônicos implantáveis (DCEI) é procedimento pouco frequente e sua realização exige longo treinamento profissional e infraestrutura adequada. [1][2][3][4][5] Embora as indicações estejam bem estabelecidas em diretrizes médicas, sua utilização varia de acordo com a expertise de cada centro, sendo usada quase que exclusivamente para o tratamento de processos infecciosos relacionados aos DCEIs nos serviços menos especializados e em maior escala em serviços com maior experiência. [2][3][4][5][6][7][8][9] Como a maioria dos dispositivos implantados utiliza o acesso venoso para o implante dos cabos-eletrodos, as técnicas transvenosas são as mais utilizadas.…”