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

Abstract

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.

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

“…Surprisingly there was no clear influence of the implantation side in uni-or multivariate analyses which might be due to the rather small number of patients receiving right-sided device implantation. The only study published to date investigating the rate of venous obstruction both prior to as well as after implantation showed a significant increase in the occurrence of obstruction from 13.7 % to 32.9 % after implantation [10], which is comparable to our own results (11.0 % prior to implantation and 30.1 % prior to upgrade/revision). Overall venous obstruction (any grade of stenosis) was described in 25 -50 % of cases after ICD placement [3,14] and in 14 -64 % after pacemaker implantation [6, 7, 9, 10, 12], but to date no direct comparison of venous obstruction rates between pacemaker and ICD patients is available.…”

“…Therefore, the aim of the present study was to investigate the incidence of upper extremity venous obstruction, and to identify risk factors in a large patient population. Venographic studies investigating venous occlusion prior to device implantation in general found a prevalence of 4.4 -13.7 % [5, 10,18]. The occurrence of upper extremity deep vein thrombosis prior to any cardiac device implantation is often associated with malignancy and/or central venous lines.…”

“…However, most of the previous reports have only included relatively small patient populations (< 100 -150 patients). Furthermore, several studies were unable to determine any statistically significant risk factors whatsoever [3,10]. As venous obstruction can seriously complicate implantation or revision of a device, it should be excluded prior to surgery (first implant or revision/repeat surgery) [3].…”

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].…”