Abstract:Background: Little is known about lead-related venous stenosis/occlusion (LRVSO), and the influence of LRVSO on the complexity and outcomes of transvenous lead extraction (TLE) is debated in the literature. Methods: We performed a retrospective analysis of venograms from 2909 patients who underwent TLE between 2008 and 2021 at a high-volume center. Results: Advanced LRVSO was more common in elderly men with a high Charlson comorbidity index. Procedure duration, extraction of superfluous leads, occurrence of an… Show more
“…9 Czajkowski et al also reported an association between the finding of occlusion on venogram and longer procedures and the need for more advanced tools. 10 Conversely, other studies utilizing either CT or venography found no difference in TLE complexity between patients with and without occlusion. 7,11 While the finding of lead-venous adherence predicted the complexity of the extraction procedure, no difference was found in complete success rates of extraction between those with and without adherence.…”
Section: Findings and Implicationsmentioning
confidence: 92%
“…Li et al studied patients with a venogram and reported that among those with occlusion, procedure times were more than 25% higher and fluoroscopy times were more than 50% higher compared to those without occlusion 9 . Czajkowski et al also reported an association between the finding of occlusion on venogram and longer procedures and the need for more advanced tools 10 . Conversely, other studies utilizing either CT or venography found no difference in TLE complexity between patients with and without occlusion 7,11 …”
“…9 Czajkowski et al also reported an association between the finding of occlusion on venogram and longer procedures and the need for more advanced tools. 10 Conversely, other studies utilizing either CT or venography found no difference in TLE complexity between patients with and without occlusion. 7,11 While the finding of lead-venous adherence predicted the complexity of the extraction procedure, no difference was found in complete success rates of extraction between those with and without adherence.…”
Section: Findings and Implicationsmentioning
confidence: 92%
“…Li et al studied patients with a venogram and reported that among those with occlusion, procedure times were more than 25% higher and fluoroscopy times were more than 50% higher compared to those without occlusion 9 . Czajkowski et al also reported an association between the finding of occlusion on venogram and longer procedures and the need for more advanced tools 10 . Conversely, other studies utilizing either CT or venography found no difference in TLE complexity between patients with and without occlusion 7,11 …”
“…All radiographic images were evaluated by the cardiac surgeon and the cardiologist with experience in interventional radiology, and venous patency was graded on a 5-degree scale from normal flow to complete occlusion as described previously. 21 Selected frames of each venogram were used to determine the degree of narrowing at each venous level and divided into five classes, ie, no stenosis (patent), mild narrowing defined as <1/3 reduction in venous diameter in the posteroanterior view ( Figure 1 ) moderate stenosis: 1/3 to 2/3 reduction in venous diameter), severe stenosis (≥2/3 narrowing, but still patent ( Figure 2 ) and complete occlusion of the axillary (AxV), subclavian (ScV), innominate (brachiocephalic) (AnV) veins and superior vena cava (SVC) ( Figure 3 ). Figure 1 Some examples of small/mild obstruction of great chest veins in compliance with chest side lead location.…”
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.
“…Furthermore, a “stepwise” approach is normally adopted so that the operator moves from simple (e.g., gentle traction using a locking stylet) to more complex strategies and tools (e.g., powered extraction sheaths) during the procedure according to the success of each single step ( 1 ). A pre-procedural contrast venography is also helpful to identify regions of venous stenosis/occlusion and adhesion sites ( 1 , 2 , 42 ).…”
Section: Transvenous Lead Extraction As Therapeutic Option In Case Of...mentioning
confidence: 99%
“…TLE of abandoned leads has also been confirmed to be a safe and effective solution to overcome venous stenosis at the time of CIED revision or upgrade. Furthermore, the presence of venous obstruction itself seems to have no impact on procedural major complications ( 42 ). In the series from Barakat et al ( 28 ) 503 patients underwent abandoned lead extraction because of lead dysfunction, lead recall or venous stenosis (37 patients).…”
Section: Transvenous Lead Extraction As Therapeutic Option In Case Of...mentioning
Over the last decades, the implementation of new technology in cardiac pacemakers and defibrillators as well as the increasing life expectancy have been associated with a higher incidence of transvenous lead complications over time. Variable degrees of venous stenosis at the level of the subclavian vein, the innominate trunk and the superior vena cava are reported in up to 50% of implanted patients. Importantly, the number of implanted leads seems to be the main risk factor for such complications. Extraction of abandoned or dysfunctional leads is a potential solution to overcome venous stenosis in case of device upgrades requiring additional leads, but also, in addition to venous angioplasty and stenting, to reduce symptoms related to the venous stenosis itself, i.e., the superior vena cava syndrome. This review explores the role of transvenous lead extraction procedures as therapeutical option in case of central venous disorders related to transvenous cardiac leads. We also describe the different extraction techniques available and other clinical indications for lead extractions such as lead infections. Finally, we discuss the alternative therapeutic options for cardiac stimulation or defibrillation in case of chronic venous occlusions that preclude the implant of conventional transvenous cardiac devices.
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