Predictors of venous obstruction following pacemaker or implantable cardioverter-defibrillator implantation: a contrast venographic study on 100 patients admitted for generator change, lead revision, or device upgrade

Abstract

Total or partial obstruction of the access veins occurs relatively frequently after pacemaker or ICD implantation. Multiple pacing or ICD leads are associated with an increased risk of venous obstruction, whereas antiplatelet/anticoagulant therapy appears to have a preventive effect on development of access vein thrombosis.

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

“…Recently, other risk factors have been described such as infection [7], lack of anticoagulation therapy [9,12], female hormones [9], previous history of thrombosis [9], multiple electrodes [9], atrial fibrillation [11], multisite pacemakers [11], previous implantation of a definitive pacemaker [8] and implantable cardioverter-defibrillator electrode lead with a double coil [8].…”

“…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.…”

Subclavian Vein Stenosis/Occlusion Following Transvenous Cardiac Pacemaker and Defibrillator Implantation: Incidence, Pathophysiology and Current Management

“…These include age, sex, pacemaker or defibrillator device, time from lead implant, lead type or material (silicone or polyurethane) and entry site, among others. 7,13 Clinical Characteristics and Diagnosis Symptomatic patients with chronic lead-related subclavian vein stenosis/occlusion often present more than one month after device implantation with painful arm swelling that may be associated with cyanosis and visible venous collaterals over the ipsilateral chest and upper extremity. Rarely, pulmonary embolism can be a presenting symptom as reported in Da Costa et al's prospective study.…”