Subclavian Vein Stenosis/Occlusion Following Transvenous Cardiac Pacemaker and Defibrillator Implantation: Incidence, Pathophysiology and Current Management

O'Leary, Brian; Allaqaband, Suhail

doi:10.17294/2330-0698.1074

Cited by 6 publications

(4 citation statements)

References 33 publications

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“…Subclavian vein stenosis is the most common complication of permanent cardiac pacemaker implantation, occurring in some 30–50% of patients. 6 , 9 However, this complication usually develops over a prolonged period of time, allowing for the development of collateral venous circulation. Therefore, venous thrombosis does not usually result in complete venous outflow obstruction in these individuals.…”

Section: Discussionmentioning

confidence: 99%

“…Nonetheless, in the immediate post-operative period before adequate collateral circulation develops, these patients are most prone to venous thrombosis and are at the highest risk of complete venous occlusion and PCD. 6 , 10 From 1993–2009, the rate of pacemaker placement in the United States increased by >55%. 11 With the increasing size of the elderly patient population in the U.S., this trend is likely to increase even more.…”

Section: Discussionmentioning

confidence: 99%

“…UEDVT is most often associated with an indwelling foreign body such as a central venous catheter (CVC) or cardiac pacemaker/defibrillator. 5 , 6 Herein we present a case of PCD of the left upper extremity (LUE) developing in a young female with a permanent cardiac pacemaker who had recently undergone re-implantation of a dislodged atrial lead. We discuss the factors involved in distinguishing PCD from the much more common and less-morbid symptomatic DVT and the potential benefits of educating both providers and patients about this rare yet serious complication.…”

Section: Introductionmentioning

confidence: 99%

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Pacemaker-associated Phlegmasia Cerulea Dolens Treated with Catheter-directed Thrombolysis

Mazer

Hughes

2018

Clinical Practice and Cases in Emergency Medicine

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Phlegmasia cerulea dolens (PCD) is a rare and severe form of deep venous thrombosis that is classically associated with the lower extremities. We report a case of upper extremity PCD developing abruptly in a 37-year-old female with an indwelling cardiac pacemaker who presented to the emergency department complaining of pain and paresthesias in her left arm, adjoining left chest wall, and inferior neck. Her condition was promptly diagnosed and successfully treated with intravenous unfractionated heparin and balloon venoplasty with catheter-directed thrombolysis without any known residual signs or symptoms at hospital discharge.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Pacemaker-associated Phlegmasia Cerulea Dolens Treated with Catheter-directed Thrombolysis

Mazer

Hughes

2018

Clinical Practice and Cases in Emergency Medicine

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“…The precise epidemiology of non-surgery related thrombotic complications in patients with transvenous leads have to date not been reviewed systematically (4,(9)(10)(11). Determination of incidences and prevalence will give insight into the burden of thrombotic complications and helps to understand the association between transvenous leads and UEDVT and asymptomatic vein occlusion.…”

Section: Introductionmentioning

confidence: 99%

Upper Extremity Deep Vein Thrombosis and Asymptomatic Vein Occlusion in Patients With Transvenous Leads: A Systematic Review and Meta-Analysis

Duijzer

Winter

Nijkeuter

et al. 2021

Front. Cardiovasc. Med.

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Aims: The presence of transvenous leads for cardiac device therapy may increase the risk of venous thromboembolisms. The epidemiology of these complications has not yet been determined systematically. Therefore, this study aims to determine (I) the incidence of symptomatic upper extremity deep vein thrombosis (UEDVT) and (II) the prevalence of asymptomatic upper extremity vein occlusion in patients with transvenous leads, both after the initial 2 months following lead implantation.Methods: PubMed, EMBASE, and Cochrane Library were searched until March 31, 2020 to identify studies reporting incidence of UEDVT and prevalence of asymptomatic vein occlusion after the initial 2 months after implantation in adult patients with transvenous leads. Incidence per 100 patient years of follow-up (PY) and proportions (%) were calculated to derive pooled estimates of incidence and prevalence.Results: Search and selection yielded 20 and 24 studies reporting on UEDVT and asymptomatic vein occlusion, respectively. The overall pooled incidence of UEDVT was 0.9 (95% CI 0.5–1.4) per 100PY after 2 months after lead implantation. High statistical heterogeneity was present among studies (I2 = 82.4%; P = < 0.001) and only three studies considered to be at low risk of bias. The overall pooled prevalence of asymptomatic upper extremity vein occlusion was 8.6% (95% CI 6.0–11.5) with high heterogeneity (I2 = 81.4%; P = <0.001). Meta-regression analysis showed more leads to be associated with a higher risk of UEDVT.Conclusion: Transvenous leads are an important risk factor for symptomatic UEDVT, which may occur up to multiple years after initial lead implantation. Existing data on UEDVT after lead implantation is mostly of poor quality, which emphasizes the need for high quality prospective research. Asymptomatic vein occlusion is present in a substantial proportion of patients and may complicate any future lead addition.Clinical Trial Registration: (URL: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020178136, Identifier: PROSPERO 2020 CRD42020178136).

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Unguided temporary pacing via jugular/subclavian vein in an emergency department of a high-volume tertiary care hospital of India: its safety, efficacy, and practicability

et al. 2022

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Background Temporary pacing is usually performed by cardiologists under fluoroscopic, echocardiographic, or ECG guidance. However, in the developing world, there are inadequate number of cardiologists, and C-arm, catheterization laboratories, or echocardiography are not available at primary or secondary healthcare facilities. In addition, in emergencies option of fluoroscopy and echocardiography is limited. So these patients are transferred to a facility where cardiologists and these facilities are available. Crucial time is lost in transit, which leads to increased mortality. In this study, we aimed to evaluate the safety, efficacy, and practicability of unguided temporary pacemaker insertion. Results A total of 1093 patients were enrolled in this study. After cannulating the internal jugular vein or subclavian vein, the pacing lead attached to the pulse generator was advanced blindly till ventricular pacing was achieved. Procedural success was taken as the primary endpoint. Secondary endpoints included the number of attempts taken for successful central venous puncture and procedural time. Complications and mortality were assessed for safety outcomes. Finally, the position of the pacing lead was assessed after the procedure on X-ray or fluoroscopy. The procedure was successful in all but one patient in whom a femoral vein approach was required because of brachiocephalic vein obstruction. Right internal jugular access was achieved in 981 (89.75%) patients. The mean number of attempts taken for achieving successful venous accesses was 1.54 ± 0.85; however, in 726 (66.42%) patients it was achieved in the first attempt. The mean procedural time was 11.5 ± 2.1 min. Overall, 117 (10.70%) patients developed complications; however, most of them were minor. Pneumothorax developed in 12 (1.1%) patients, of whom 2 needed an intercostal tube. Pericardial effusion was seen in 21 (1.92%) patients. Pacing lead tip was located in the right ventricular cavity abutting interventricular septum or free wall in 843 (77.20%) patients. No mortality attributable to procedure occurred. Conclusions Unguided temporary pacing via jugular or subclavian venous approach in an emergency setting is possible with high success and a low complication rate. Thus, it is a safe and effective procedure, and clinicians working at primary and secondary healthcare levels should be encouraged to perform this procedure. Trial registration UMIN Clinical Trials Registry, UMIN000046771. Registered 28 January 2022—Retrospectively registered, https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000053348

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Subclavian Vein Stenosis/Occlusion Following Transvenous Cardiac Pacemaker and Defibrillator Implantation: Incidence, Pathophysiology and Current Management

Abstract: Journal of Patient-Centered Research and Reviews ( JPCRR) is a peerreviewed scientific journal whose mission is to communicate clinical and bench research findings, with the goal of improving the quality of human health, the care of the individual patient, and the care of populations.

Cited by 6 publications

References 33 publications

Pacemaker-associated Phlegmasia Cerulea Dolens Treated with Catheter-directed Thrombolysis

Pacemaker-associated Phlegmasia Cerulea Dolens Treated with Catheter-directed Thrombolysis

Upper Extremity Deep Vein Thrombosis and Asymptomatic Vein Occlusion in Patients With Transvenous Leads: A Systematic Review and Meta-Analysis

Unguided temporary pacing via jugular/subclavian vein in an emergency department of a high-volume tertiary care hospital of India: its safety, efficacy, and practicability

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