Venous Stenosis and Occlusion in the Presence of Endocardial Leads

Boczar, Krzysztof; Ząbek, Andrzej; Haberka, Kazimierz; Hardzina, Małgorzata; Dębski, Maciej; Rydlewska, Anna; Nowosielska-Ząbek, Ewa; Lelakowski, Jacek; Małecka, Barbara

doi:10.17219/acem/42317

Cited by 20 publications

(20 citation statements)

References 13 publications

(45 reference statements)

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“…Venous obstructions frequently occur in patients with transvenous cardiac implantable electronic devices (CIED), with an estimated 14 to 64% prevalence. 1 - 11 Those lesions are mostly asymptomatic, although visible collateral circulation in the thoracic region is usually found. Although deep venous thrombosis, pulmonary thromboembolism, or superior vena cava syndrome were found in 1.6 to 12% of the cases, the difficulty in gaining access to implant new additional leads or other types of transvenous devices has been the main consequence of those lesions.…”

Section: Introductionmentioning

confidence: 99%

Usefulness of preoperative venography in patients with cardiac implantable electronic devices submitted to lead replacement or device upgrade procedures

Albertini¹,

Silva²,

Motta-Leal-Filho³

et al. 2018

Arquivos Brasileiros De Cardiologia

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BackgroundVenous obstructions are common in patients with transvenous cardiac implantable electronic devices, but they rarely cause immediate clinical problems. The main consequence of these lesions is the difficulty in obtaining venous access for additional leads implantation.ObjectivesWe aimed to assess the prevalence and predictor factors of venous lesions in patients referred to lead reoperations, and to define the role of preoperative venography in the planning of these procedures.MethodsFrom April 2013 to July 2016, contrast venography was performed in 100 patients referred to device upgrade, revision and lead extraction. Venous lesions were classified as non-significant (< 50%), moderate stenosis (51-70%), severe stenosis (71-99%) or occlusion (100%). Collateral circulation was classified as absent, discrete, moderate or accentuated. The surgical strategy was defined according to the result of the preoperative venography. Univariate analysis was used to investigate predictor factors related to the occurrence of these lesions, with 5% of significance level.ResultsModerate venous stenosis was observed in 23%, severe in 13% and occlusions in 11%. There were no significant differences in relation to the device side or the venous segment. The usefulness of the preoperative venography to define the operative tactic was proven, and in 99% of the cases, the established surgical strategy could be performed according to plan.ConclusionsThe prevalence of venous obstruction is high in CIED recipients referred to reoperations. Venography is highly indicated as a preoperative examination for allowing the adequate surgical planning of procedures involving previous transvenous leads.

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Section: Introductionmentioning

confidence: 99%

Usefulness of preoperative venography in patients with cardiac implantable electronic devices submitted to lead replacement or device upgrade procedures

Albertini¹,

Silva²,

Motta-Leal-Filho³

et al. 2018

Arquivos Brasileiros De Cardiologia

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“…In few reports female hormone use [5], personal history of venous thrombosis [5], left ventricle ejection fraction under 40% [12], and use of dualcoil ICD leads [6] and infection [19] were associated with higher incidence of obstruction. However, diabetes mellitus [11] and prophylaxis with Warfarin [20] lowered the probability of venous stenosis.…”

Section: Discussionmentioning

confidence: 99%

“…The incidence of thrombosis was estimated to be about 23% during the first year of implantation in a study using doppler ultrasound [5]. In studies performing contrast venography, as the gold standard method for detection of venous occlusion, significant abnormal venography results after implantation were detected in 24 to 45% [4,[9][10][11][12][13]. Most of these previous reports did not investigate the venous system prior to implantation except in one, reported by Oginosawa et al They showed that incidence of significant venous obstruction was observed in 32.9% of the patients during 44 months post implantation.…”

Section: Discussionmentioning

confidence: 99%

Upper extremity deep venous thrombosis and stenosis after implantation of pacemakers and defibrillators; A prospective study

Safi

Akbarzadeh

Azinfar

et al. 2017

Romanian Journal of Internal Medicine

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Background. Obstruction of the access vein following cardiac pacemaker and defibrillator implantation is a common complication. However, the exact incidence and contributing risk factors are unknown. The aim of this study is to determine the incidence and analyze the contribution of each risk factor.Methods. 57 consecutive patients candidate for their first transvenous pacemaker, implantable cardioverter-defibrillator (ICD), or cardiac resynchronization therapy device implantation were enrolled. After implantation, venography of the ipsilateral peripheral arm was performed. Patients underwent their second venography after the follow-up period of 3 to 6 months.Results. 42 patients (13 females, mean age 59.71 ± 12.33) completed the study. The followup venography showed significant venous obstruction (more than 50%) in 9 (21%) patients, but in none of the individuals, venography revealed total occlusion of the veins. Patients with obstruction had more leads in their veins (2.56 ± 0.53 vs 1.58 ± 0.71, P = 0.001). Venous obstruction was significantly more prevalent in patients with implanted cardiac resynchronization therapy device compared with an ICD or pacemaker (p = 0. 01). Age, gender, diabetes mellitus, hypertension, ischemic heart disease and antiplatelet consumption did not reveal any other contribution to the risk of thrombosis. In multivariate analysis, total lead number was a positive predictor for venous occlusion (P = 0.015, OR:19.2, and CI: 1.7-207.1).Conclusion. Venous obstruction is relatively frequent after pacemaker or ICD implantation. This study also shows that pacemaker and ICD leads have a similar risk for lead-related venous obstruction. However, patients with multiple leads are associated with an increased risk.

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“…Narrowing of the vessel due to the presence of more leads and endothelial damage due to physical manipulation may make the vein susceptible to thrombosis and fibrotic scarring ( 25 ). Female gender ( 26 ) and diabetes ( 27 ) have a protective effect against the development of CVO.…”

Section: Discussionmentioning

confidence: 99%

Are Endovascular Interventions for Central Vein Obstructions due to Cardiac Implanted Electronic Devices Effective?

et al. 2018

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Objective: One of the late-onset complications of cardiac implanted electronic devices (CIEDs) is central venous obstruction (CVO). The aim of this study was to investigate the feasibility, efficacy, and safety of endovascular treatment of CIED-related CVOs.Methods:Eighteen patients who underwent endovascular management of their device-related CVO were reviewed. Patients were classified into three groups: Group I patients were asymptomatic and needed lead replacement; Group II patients presented with symptomatic CVO without lead dysfunction, and Group III patients were referred with both symptomatic CVO and lead dysfunction. A treatment strategy involved recanalization and balloon angioplasty for Group I and angioplasty/stents for Groups II and III. Technical success, clinical success, complications, and long-term follow-up were assessed.Results: Thirteen patients were in Group I, four in Group II, and one in Group III. Technical and clinical success was achieved in 17 patients (94%). No major complications were reported. Restenosis was observed in two patients at 40 and 42 weeks of follow-up, and these patients were successfully treated with angioplasty.Conclusion: Endovascular management of CVO due to CIED is a safe and efficient technique. Plain balloon angioplasty is sufficient for lead replacement purposes, while stenting is needed for symptomatic CVO to achieve good long-term patency.

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Venous Stenosis and Occlusion in the Presence of Endocardial Leads

Cited by 20 publications

References 13 publications

Usefulness of preoperative venography in patients with cardiac implantable electronic devices submitted to lead replacement or device upgrade procedures

Usefulness of preoperative venography in patients with cardiac implantable electronic devices submitted to lead replacement or device upgrade procedures

Upper extremity deep venous thrombosis and stenosis after implantation of pacemakers and defibrillators; A prospective study

Are Endovascular Interventions for Central Vein Obstructions due to Cardiac Implanted Electronic Devices Effective?

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