Severity and Extent of Lead-Related Venous Obstruction in More Than 3000 Patients Undergoing Transvenous Lead Extraction

Abstract

Background Lead-related venous stenosis/obstruction (LRVSO) may be a major challenge in patients with cardiac implantable electronic devices (CIED) when device upgrade, insertion of central lines, or creation of an arteriovenous fistula for hemodialysis is indicated. The aim of this study was to evaluate the extent and severity of LRVSO. Methods We performed a retrospective analysis of 3002 venograms from patients awaiting transvenous lead extraction (TLE) to assess the occurrence, severity, and extent of LRVSO. Results Mild LRVSO occurred in 19.9%, moderate in 20.7%, severe in 19.9% and total venous occlusion in 22.5% of the patients. Moderate/severe stenosis or total occlusion of the subclavian and brachiocephalic veins was found in 38.2% and 22.5% of the patients, respectively. LRSVO was not detected in 16.9% of the patients. Moderate and severe superior vena cava (SVC) obstruction and total SVC occlusion were rare (0.4%, 0.3%, and 0.3%, respectively). Lead insertion on the left side of the chest contributed to an increased risk of LRVSO compared to right-sided implantation. Major thoracic veins on the opposite side may be narrowed in varying degrees. Conclusion A total of 60% of the patients with pacemaker or high-voltage leads have an advanced form of LRVSO. Any attempt to insert new pacing leads, central lines, venous ports, or catheters for hemodialysis, or to create dialysis fistula on the same side as the existing lead should be preceded by venography. Furthermore, venography may provide useful information, if it is planned to implant the lead or the catheter on the opposite side of the chest.

Prevalence and Predictors of venous stenosis following first transvenous cardiac implantable electronic device implantation.

“…Besides, the absence of a baseline venogram may overestimate the incidence of VSO. We found that subclavian and brachiocephalic veins are the most commonly affected veins, as found in other studies [ 21 ]. One study [ 11 ] showed that stenosis developed at the same point where the vessel was narrowest already before lead implantation.…”

Arteriovenous Access for Hemodialysis

“…4 Clinicians should be aware that vascular procedures (eg, peripheral insertion of a central catheterization line, cardiac catheterization performed via the radial artery), CVC placement or central venous instrumentation (eg, cardiac pacers, defibrillators), or even venipuncture in the antecubital fossa may impede the patient's future hemodialysis access options and procedures. [5][6][7] For example, peripherally inserted central catheters can damage the vein or cause stenosis or thrombosis of the median cubital, cephalic, axillary, brachiocephalic, and subclavian veins so that these vessels are not usable for arteriovenous access creation. Patients with chronic kidney disease who may need dialysis should be instructed to have venipuncture only on the back of their hands, if possible, rather than in the antecubital fossa to limit vessel damage and thus preserve veins for arteriovenous access creation.…”

Superior vena cava obstruction and cardiovascular implantable electronic devices—a new era of leadless devices

“…In a retrospective analysis of 3,002 venograms from patients awaiting transvenous lead extraction, Czajkowski et al observed that SVC occlusion was rare ( 31 ). Their research group also described risk factors for lead-related venous obstruction and the influence of lead-related venous obstruction on the complexity and outcomes of lead extraction ( 32 , 33 ).…”