Echographic Detection of Latent Severe Thrombotic Stenosis of the Superior Vena Cava and Innominate Vein in Patients with a Pacemaker: Integrated Diagnosis Using Sonography, Pulse Doppler, and Color Flow

Abstract

Thrombosis of the innominate vein and SVC is a serious complication in patients with pacemakers, inducing pulmonary embolism or SVC syndrome. Venography is the definitive method for its diagnosis; however, it is too invasive for related studies. The purpose of this study was to validate sonography, pulse Doppler, and color flow in detecting noninvasively innominate vein or SVC thrombosis in patients with pacemakers. In 53 patients with pacemakers, the 1 severe SVC stenosis and 18 severe innominate vein stenoses due to thrombosis were diagnosed by digital subtraction angiography. Sonography accurately showed the severe SVC stenosis due to thrombosis, but had limitations on the innominate vein thrombosis. Color flow demonstrated mosaic flow, indicating poststenotic turbulence due to stenosis of the innominate vein and SVC caused by thrombosis in 15 of 16 patients, and pulse Doppler disclosed absence of flow due to complete occlusion of the innominate vein in 2 of 2 patients. Sensitivity and specificity for detecting severe innominate vein stenosis due to thrombosis using combined color flow and pulse Doppler was 94% and 100%, respectively. In conclusion, sonography, pulse Doppler, and color flow allow accurate detection of severe innominate vein or SVC stenosis due to thrombosis, and are therefore useful for the follow-up of patients with a pacemaker.

Clinical Significance of Collateral Superficial Vein Across Clavicle in Patients With Cardiovascular Implantable Electronic Device

“…Recently, venous Doppler ultrasonography has been utilized in some prospective studies, but has limitations in diagnosing innominate vein obstruction. 2,6, 16 Well-developed superficial veins are frequently observed on the skin surface around the CIED during follow-up. In the case Superficial Vein Across Clavicle in CIED Patients nization therapy-defibrillator (CRT-D) or cardiac resynchronization therapy-pacemaker (CRT-P).…”

“…According to Nishino et al, ultrasonography can accurately show severe access vein stenosis due to thrombosis after CIED implantation. 16 It was difficult, however, to visually detect the proximal or distal innominate vein and superior vena cava precisely on ultrasonography. We first focused on the superficial veins on the skin surface around the CIED, and found a collateral superficial vein across the clavicle to be a simple and non-invasive marker to predict venous obstruction without difficulty compared with ultrasonography.…”

Echocardiography of the superior vena cava

“…Venography is the definitive method for its diagnosis; however, in a study on 53 patients with pacemakers, sensitivity and specificity for detecting severe innominate vein stenosis due to thrombosis using combined color-flow and pulse Doppler were 94 and 100%, respectively. 10 Superior vena caval syndrome may be caused by extravascular compression or intravascular obstruction. Knowing the mechanism of SVC syndrome allows the physician to choose appropriate treatment.…”

An Occult Cause of Arteriovenous Access Failure: Central Vein Stenosis from Permanent Pacemaker Wire

“…Although the pathogenesis of central vein stenosis remained speculative, it is plausible that proliferation and fibrosis resulting from endothelial injury of puncture site and irritation of pacing wire play an imperative role. The incidence of central vein stenosis following permanent pacemaker implantation is reported to be 11-60% [1][2][3]. It might be underestimated in the absence of clinical symptoms and variable with different sensitivity between radiological modalities.…”

“…It might be underestimated in the absence of clinical symptoms and variable with different sensitivity between radiological modalities. Venous Doppler sonogram has considerable limitations [2,3], while venography has the greatest diagnostic value for screening studies.…”