Venous Access Thrombosis Detected by Transcutaneous Vascular Ultrasound in Patients with Single‐Polyurethane‐Lead Permanent Pacemaker

Lin, Li Jen; Lin, Jiunn Lee; Tsai, Wei Chuan; Teng, Jeng Kai; Tsai, Liang Miing; Chen, Jyh Hong

doi:10.1111/j.1540-8159.1998.tb00063.x

Cited by 14 publications

(11 citation statements)

References 8 publications

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“…The risk of venous abnormalities associated with pacemaker leads in prospective studies reported in the literature ranges from 5.5% to 64% 2,6–10 . Only one study systematically used Doppler ultrasound to specifically detect venous thrombosis after pacemaker implantation.…”

Section: Discussionmentioning

confidence: 99%

Incidence and Risk Factors of Early Venous Thrombosis Associated with Permanent Pacemaker Leads

Rooden¹,

Molhoek

Rosendaal

et al. 2004

Cardiovasc electrophysiol

160

153

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Introduction: Pacemaker lead implantation can cause thrombosis, which can be associated with serious local morbidity and complicated by pulmonary embolism. Few reliable estimates of the incidence of thrombosis have been reported. The contribution of established risk factors to venous thrombosis in patients with implanted pacemaker leads is unknown. Methods and Results: One hundred forty‐five consecutive patients n = 145) underwent routine clinical and Doppler ultrasound evaluation for thrombosis before and 3, 6, and 12 months after lead implantation. Established risk factors for venous thrombosis were assessed in detail for all patients. Clinical outcome, including clinically manifest thrombosis, pulmonary embolism, associated pacemaker lead infection, complicated reinterventions, and death, was evaluated. Thrombosis was observed in 34 (23%) of 145 patients. Thrombosis did not cause any signs or symptoms in 31 patients but resulted in overt clinical symptoms in 3 patients. The absence of anticoagulant therapy, use of hormone therapy, and a personal history of venous thrombosis were associated with an increased risk of thrombosis. The risk of thrombosis increased in the presence of multiple pacemaker leads compared to a single lead. Conclusion: Established risk factors for venous thrombosis and the presence of multiple pacemaker leads contribute substantially to the occurrence of thrombosis associated with permanent pacemaker leads. Risk factor assessment prior to implantation may be useful for identifying patients at risk for thrombotic complications. Preventive management in these patients is warranted.

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Section: Discussionmentioning

confidence: 99%

Incidence and Risk Factors of Early Venous Thrombosis Associated with Permanent Pacemaker Leads

Rooden¹,

Molhoek

Rosendaal

et al. 2004

Cardiovasc electrophysiol

160

153

View full text Add to dashboard Cite

show abstract

“…For example, it is difficult to visually detect the proximal or distal innominate vein and superior vena cava precisely by ultrasonography. 6 Furthermore, venogram uses a film-screen combination, large amounts of contrast material, and provides images of the venous system that are frequently overlapped by bony structures. 7 Intravenous DSA has overcome these disadvantages of imaging the venous anatomy.…”

Section: Discussionmentioning

confidence: 99%

“…tion fraction (LVEF) were measured using the echocardiography. Mean LAD and LVEF were 37.8 6 8.0% and 64.8 6 13.5%, respectively. Cardiothoracic ratio (CTR) on chest X ray was mean 54.7 6 6.9%.…”

mentioning

confidence: 94%

The Incidence and Risk Factors for Venous Obstruction After Implantation of Transvenous Pacing Leads

Oginosawa

Abe

Nakashima

2002

Pacing Clinical Electrophis

119

130

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Several investigators have shown that the incidence of venous obstruction after pacemaker implantation was observed in 31-50% of pacemaker patients. However, these previous reports did not investigate the venous system prior to implantation. The aim of this study was to determine the incidence and risk factors for venous obstruction in patients with transvenous pacing leads. The study included 131 consecutive patients (64 men, 67 women; mean age 71.3 +/- 9.8 years) who were investigated using intravenous digital subtraction angiography (DSA) before and after permanent pacemaker implantation. Follow-up DSA was performed for a mean interval of 44 +/- 6 months after pacemaker lead implantation in 79 of 131 patients. A diameter narrowing > 60% was defined as an obstruction. Prior to implantation of pacing leads, venous obstruction was present in 18 (13.7%) of 131 patients. In 15 of these 18 patients, the obstruction was present at the site of the left innominate vein. Follow-up DSA, after implantation of pacing leads, showed that venous obstruction was observed in 26 (32.9%) of 79 patients. There were no significant differences between obstruction and nonobstruction groups in terms of age, sex, cardiothoracic ratio, left atrial dimension, left ventricular ejection fraction, baseline heart diseases for indication of pacemaker implantation, or number and body size of pacing leads. Neither clinical symptoms nor abnormal physical findings were observed in any patients. In conclusion, the incidence of venous obstruction after pacing lead implantation is less than that of previous reports, which might be related to the incidence of venous obstruction before pacing leads implantation.

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“…28 Studies show that the incidence may be higher. 29,30 As with catheter-associated UEDVT, most pacemakerassociated cases are asymptomatic because thrombosis occurs slowly, allowing time for the development of collateral circulation. 28 This collateral flow may contribute to false-negative venous ultrasound test results, and venography may be required to exclude UEDVT.…”

Section: Central Venous Catheterization and Uedvtmentioning

confidence: 99%

“…Clinical symptoms of UEDVT have been reported to occur from 1 month to more than 7 years following pacemaker implantation. Lin et al 30 used ultrasound techniques to study 109 asymptomatic patients with implanted pacemakers and found significant thrombi in 6 (5.5%) patients. Barazzoni UEDVT may also complicate the use of peripheral venous catheters and peripherally inserted central venous catheters, 31 although the incidence in one consecutive series of over 3000 patients was only 1%.…”

Section: Central Venous Catheterization and Uedvtmentioning

confidence: 99%

Upper Extremity Deep Venous Thrombosis

Kommareddy¹,

Zaroukian²,

Hassouna³

2002

Semin Thromb Hemost

127

109

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Upper extremity deep venous thrombosis (UEDVT) makes up approximately 1-4% of all episodes of deep venous thrombosis (DVT). Risk factors for UEDVT include central venous catheterization, strenuous upper extremity exercise or anatomic abnormalities causing venous compression, inherited thrombophilia, and acquired hypercoagulable states including pregnancy, oral contraceptive use, and cancer. Unexplained or recurrent UEDVT should prompt a search for inherited hypercoagulable states or underlying malignancy. Clinical presentations include arm, neck, and shoulder pain; edema; skin discoloration; tenderness; and venous distension. Because UEDVT is frequently asymptomatic until complications ensue, a high index of suspicion is required for patients with one or more risk factors for thrombosis. Pulmonary embolism and post-thrombotic syndrome are the most common sequelae of UEDVT. Early detection and treatment of UEDVT decrease complications, morbidity, and mortality. Compressive ultrasonography is an effective and economical means of confirming the clinical diagnosis in most patients. Traditional anticoagulant therapy of UEDVT is giving way to a multimodal approach involving transcatheter thrombolytic therapy followed by a minimum of 3 months of warfarin sodium anticoagulant therapy, venous decompression as needed, and balloon angioplasty with stenting for treatment of residual stricture. Low-dose anticoagulant therapy can safely and effectively mitigate the increased risk of UEDVT associated with the use of central venous catheters.

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Venous Access Thrombosis Detected by Transcutaneous Vascular Ultrasound in Patients with Single‐Polyurethane‐Lead Permanent Pacemaker

Cited by 14 publications

References 8 publications

Incidence and Risk Factors of Early Venous Thrombosis Associated with Permanent Pacemaker Leads

Incidence and Risk Factors of Early Venous Thrombosis Associated with Permanent Pacemaker Leads

The Incidence and Risk Factors for Venous Obstruction After Implantation of Transvenous Pacing Leads

Upper Extremity Deep Venous Thrombosis

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