Venous Occlusion of the Access Vein in Patients Referred for Lead Extraction:

Abstract

The aim of this study was to determine the effect of patient and lead characteristics on occlusion of the access vein in pacemaker and ICD patients. Contrast venography of the access vein was obtained in 89 patients (17 patients with an ICD) scheduled for lead extraction. The indication for extraction was infection in 57 patients (systemic infection in 9) and lead malfunction in 32 patients. In 6 of the 89 patients, leads were introduced in both the right and left subpectoral area, resulting in a total of 95 venous entry sites. In 22 of these entry sites one lead was present, in 61 two leads, in 11 three, and in 1 four leads. The vessel patency was graded open or occluded. Occlusion of the subclavian vein occurred in four (13%) patients with lead malfunction versus 18 (32%) patients with infection (P = 0.07). In patients with systemic infection, 5 of 9 showed venous occlusion (P = 0.01 when compared to patients with malfunction, odds ratio 8.75, 95% confidence interval 1.21-64.11). Considered per entry site, the incidence of occlusion was 7 of 22 with one lead present, 17 of 61 with two leads, 0 of 11 with three leads, and 0 of 1 with four leads (P = 0.13). No patient had a superior vena caval occlusion. Patients with systemic infection have an increased risk of occlusion of the access vein. On the contrary, the study found no support for the concept that the risk of venous occlusion increases with a higher number of leads present.

Venous Obstruction in Asymptomatic Patients Undergoing First Implantation or Revision of a Cardiac Pacemaker or Implantable Cardioverter-Defibrillator: A Retrospective Single Center Analysis

“…Additionally, previous thrombosis was identified as a risk factor in univariate analysis in the present study. However, in contrast to previous studies [6 -9, 12,14], the number of implanted leads, device type (ICD, pacemaker), previous central line placement as well as history of malignancy were not significantly associated with venous obstruction. Especially the impact of multiple leads is of interest when considering possible lead extraction of superfluous leads [20].…”

Varfarina previne obstruções venosas pós-implante de dispositivos cardíacos em pacientes de alto risco: análise parcial

“…Venous obstructions after transvenous implantation of electronic cardiac devices have been described as the commonest complication related to this approach [1][2][3][4][5][6][7][8][9][10][11][12], with ventricular dysfunction and the presence of temporary pacemakers ipsilateral to the implantation side being risk factors for its occurrence [6].…”

“…With the high risk of venous lesions, 3% to 10% of patients present with clinical manifestations, of which, deep venous thrombosis of the arms is the commonest complication [1][2][3][4][5][6][7][8][9][10][11][12]. Severe complications, such as pulmonary embolism and superior vena cava syndrome, with rates that vary between 0.6% and 5%, have been rarely described in the literature, [13][14][15][16][17].…”

“…Prevention of these complications is important both because of their high incidence and clinical manifestations and the difficulties of reoperations to substitute or implant additional electrode leads and to perform other diagnostic or therapeutic interventions that depend on this venous access [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18]. The lack of contusion-related evidence that justifies the use of prophylactic strategies thus demonstrating their efficacy and safety impedes the routine application of this stratagem.…”

Successful implantation of a Micra leadless pacemaker via collateral femoral vein and inferior vena cava filter

“…After implementation of a transvenous pacemaker, the incidence of venous obstruction is approximately 12–15% 2, 6. This patient's risk was undoubtedly higher given his thrombophilia due to protein C/S deficiency.…”