Severity and Extent of Lead-Related Venous Obstruction in More Than 3000 Patients Undergoing Transvenous Lead Extraction

Abstract

Marek Czajkowski,1 Wojciech Jacheć,2 Anna Polewczyk,3,4 Jarosław Kosior,5 Dorota Nowosielecka,6 Łukasz Tułecki,7 Paweł Stefańczyk,6 Andrzej Kutarski8 1Department of Cardiac Surgery, Medical University of Lublin, Lublin, Poland; 2Department of Cardiology, Zabrze, Faculty of Medical Science in Zabrze, Medical University of Silesia in Katowice, Zabrze, Poland; 3Department of Physiology, Pathophysiology and Clinical Immunology, Collegium Medicum of Jan Kochanowski University, Kielce, Poland; 4Department of Cardiac Surgery, Świętokrzyskie Center of Cardiology, Kielce, Poland; 5Department of Cardiology, Masovian Specialistic Hospital of Radom, Radom, Poland; 6Department of Cardiology, The Pope John Paul II Province Hospital of Zamość, Zamość, Poland; 7Department of Cardiac Surgery, The Pope John Paul II Province Hospital of Zamość, Zamość, Poland; 8Department of Cardiology, Medical University of Lublin, Lublin, PolandCorrespondence: Anna Polewczyk, Department of Physiology, Pathophysiology and Clinical Immunology, Collegium Medicum of Jan Kochanowski University, Aleja IX Wieków Kielc 19A, Kielce, 25-317, Poland, Tel [phone], Email [email protected]: Lead-related venous stenosis/obstruction (LRVSO) may be a major challenge in patients with cardiac implantable electronic devices (CIED) when device upgrade, insertion of central lines, or creation of an arteriovenous fistula for hemodialysis is indicated. The aim of this study was to evaluate the extent and severity of LRVSO.Methods: We performed a retrospective analysis of 3002 venograms from patients awaiting transvenous lead extraction (TLE) to assess the occurrence, severity, and extent of LRVSO.Results: Mild LRVSO occurred in 19.9%, moderate in 20.7%, severe in 19.9% and total venous occlusion in 22.5% of the patients. Moderate/severe stenosis or total occlusion of the subclavian and brachiocephalic veins was found in 38.2% and 22.5% of the patients, respectively. LRSVO was not detected in 16.9% of the patients. Moderate and severe superior vena cava (SVC) obstruction and total SVC occlusion were rare (0.4%, 0.3%, and 0.3%, respectively). Lead insertion on the left side of the chest contributed to an increased risk of LRVSO compared to right-sided implantation. Major thoracic veins on the opposite side may be narrowed in varying degrees.Conclusion: A total of 60% of the patients with pacemaker or high-voltage leads have an advanced form of LRVSO. Any attempt to insert new pacing leads, central lines, venous ports, or catheters for hemodialysis, or to create dialysis fistula on the same side as the existing lead should be preceded by venography. Furthermore, venography may provide useful information, if it is planned to implant the lead or the catheter on the opposite side of the chest.Keywords: lead-related venous obstruction, risk factors, abandoned leads

Keywords

• lead-related venous obstruction
• risk factors
• abandoned leads