Implant Program, Heart Center, Lancaster General Hospital, Lancaster, Pennsylvania, USA.
Heart Rhythm. 2011 Apr;8(4):526-33. doi: 10.1016/j.hrthm.2010.12.014. Epub 2010 Dec 13.
The need to add a lead(s) despite subclavian/innominate obstruction is increasing. Subclavian venoplasty may be a good alternative to the commonly employed options; however, there are few reports in the literature, and all are by interventional radiologists.
To describe the procedural details, results and safety of venoplasty by implanting physicians in a large group of consecutive patients.
Safety, lead function and success were established from review of the procedure reports and clinical complications in 373 consecutive venoplasty patients from 1999-2010. Procedural details were obtained by review of the angiograms (venograms) and procedural flow charts of 152 consecutive patients from 2004-2007.
Venoplasty was successful in 371 of 373 patients without damage to the existing leads and without clinical complications. Total angiographic occlusion was demonstrated in 65% of cases by peripheral venogram, but in only 20% of cases by contrast injection at the site of obstruction; 86% were crossed with a hydrophilic wire. Microdissection and excimer laser were used to cross three of the four wire-refractory occlusions. Obstruction was both central and peripheral in 22.1% of cases and central only in 17%. The time required to cross the obstruction and perform venoplasty was 13 ± 21 minutes. A noncompliant balloon was successful in most, but an ultranoncompliant balloon was required in 13% of cases. Contrast extravasation was common during crossing of a total obstruction and also was observed with balloon rupture on three occasions, but was not clinically significant.
Subclavian venoplasty is a safe, practical lead-management option that can be used by implanting physicians.
尽管锁骨下/无名动脉阻塞，但需要添加导丝的情况越来越多。锁骨下静脉成形术可能是一种替代常用方法的良好选择；然而，文献中报道很少，且均由介入放射科医生完成。
描述植入医生在一大组连续患者中进行静脉成形术的程序细节、结果和安全性。
通过对 1999 年至 2010 年期间 373 例连续静脉成形术患者的手术报告和临床并发症进行回顾，确立了安全性、导丝功能和成功率。通过对 2004 年至 2007 年期间 152 例连续患者的血管造影（静脉造影）和手术流程图进行回顾，获得了手术细节。
373 例患者中，371 例静脉成形术成功，未损坏现有导丝，且无临床并发症。外周静脉造影显示 65%的病例完全血管闭塞，但仅在阻塞部位的对比剂注射时显示 20%的病例完全闭塞；86%的病例用亲水导丝穿过。微解剖和准分子激光用于穿过三条导丝不可通过的闭塞。22.1%的病例阻塞为中心和外周，17%的病例阻塞仅为中心。穿过阻塞并进行静脉成形术所需的时间为 13±21 分钟。大多数情况下，顺应性差的球囊成功，但 13%的病例需要使用超顺应性球囊。在完全阻塞的穿越过程中，对比剂外渗很常见，在三次球囊破裂时也观察到这种情况，但无临床意义。
锁骨下静脉成形术是一种安全、实用的导丝管理选择，可由植入医生进行。
