Types of left brachiocephalic vein aberrations detected during cardiac implantable electronic device implantation procedures

Abstract

Background: Cardiac implantable electronic device (CIED) implantation procedures with transvenous lead placement afford an opportunity to observe vascular anatomic variations.The course of CIED implantation depends largely on morphometric and topographic characteristics of the relevant brachiocephalic vein (BCV), which is the left BCV in the case of lead insertion via the left clavipectoral triangle. This study aims to present left BCV anomalies arising from abnormal systemic vein embryogenesis and encountered during CIED implantation.Materials and methods: Venograms obtained during CIED implantation procedures and illustrating left BCV topography/morphometry were analyzed retrospectively for two types of anomalies: anomalies of the left BCV itself (data from the period 2014-2018) and a combination of left BCV variations with a persistent left superior vena cava (PLSVC); since the latter instances are rare, the analyzed period was longer (2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013)(2014)(2015)(2016)(2017)(2018).Results: Analysis of data from the first, 5-year-long, period included data from a group of 1,812 patients and revealed 5 cases (0.3%) of developmental left-BCV anomalies (3 double left BCV and 2 cases of a single subaortic left BCV). The 16-year long analyzed period included 6,110 CIED implantation procedures, which showed 12 cases of PLSVC (0.2%) including 4 cases (33%) of left BCV agenesis. 2 Conclusions:The analyzed venograms rarely showed isolated left-BCV aberrations (0.3%), with the combination of left-BCV agenesis and PLSVC being much more common (33%). The morphometry and/or topography of aberrant left-BCV may result in difficulties during cardiac lead insertion.

Systemic venous anomalies in a child with a vein of Galen

“…It is well established that, by its complex embryological development, the brachiocephalic vein can show various arrangements, including an atypical superior location and duplication. [ 2 3 4 5 6 ] In our patient, the brachiocephalic veins joined anterior to the trachea, and no structures were trapped between them. We believe that it is unlikely for the brachiocephalic veins to cause airway compression, as they are soft vascular structures and likely to elongate as the child grows.…”

Left brachiocephalic vein vascular ring on CT: A rare venous anomaly

“…Notably, no other cardiac structural abnormalities were observed in this case of anomalous LBCV. Prior retrospective studies on demographic characteristics of LBCV cases demonstrated a mean age of diagnosis of 4 years and 9 months with a male predominance of 1.5:1, but these studies are limited by sample size due to the rarity of this anomaly [1 , 4] . Risk factors for anomalous development of the LBCV are unknown, but are possibly similar to those associated with other congenital cardiac malformations, such as uncontrolled maternal diabetes, intrauterine alcohol or tobacco exposure, or chromosomal abnormalities [3] .…”