Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy.
Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy.
Heart Rhythm. 2020 Feb;17(2):258-264. doi: 10.1016/j.hrthm.2019.08.012. Epub 2019 Aug 10.
In recent years, upgrade and revision procedures of cardiac implantable electronic devices (CIEDs) have become increasingly frequent. Patency of the access veins is critical for procedural success.
The purpose of this study was to determine the incidence of venous obstruction at the time of system revision, to identify predictors of venous stenosis, and to evaluate the efficacy and safety of percutaneous techniques for overcoming stenosis.
All patients admitted to our division from January 2004 to January 2017 for CIED revision with the intent to add 1 or more leads were included. Each patient underwent ipsilateral contrast venography. The degree of venous stenosis was determined with the support of quantitative coronary angiography and categorized as significant (75%-90%), subocclusive (90%-99%), or occlusive (100%).
Of 227 patients, 61 (27%) showed a stenosis >75%. Different techniques were performed to overcome stenosis: direct vein access, distal venous puncture central to the stenosis, and percutaneous venoplasty in 25 (41%), 26 (43%) and 9 (15%) cases. respectively. All procedures were successful, without major complications. At multivariate analysis, having 3 leads before revision (odds ratio 0.444; 95% confidence interval 0.212-0.920; P = .029) and a previous system revision with lead insertion (odds ratio 0.323; 95% confidence interval 0.124-0.841; P = .021) were independent predictors of venous stenosis.
Chronic venous obstruction is a relatively frequent finding after CIED implantation. The number of implanted leads seems to be an independent predictor of venous obstruction. In case of stenosis, the preprocedural angiography-guided structured approach allowed preservation of both contralateral access and functioning leads.
近年来，心脏植入式电子设备（CIED）的升级和修订程序变得越来越频繁。静脉通畅对于手术成功至关重要。
本研究旨在确定系统修订时静脉阻塞的发生率，确定静脉狭窄的预测因素，并评估经皮技术克服狭窄的疗效和安全性。
所有于 2004 年 1 月至 2017 年 1 月因 CIED 修订而入院且打算增加 1 个或多个导联的患者均纳入本研究。每位患者均接受同侧对比静脉造影。采用定量冠状动脉造影术支持确定静脉狭窄程度，并将其分为显著狭窄（75%-90%）、次闭塞（90%-99%）或闭塞（100%）。
在 227 例患者中，61 例（27%）显示狭窄>75%。为克服狭窄采用了不同技术：直接静脉入路、狭窄中心的远端静脉穿刺和经皮静脉成形术，分别在 25 例（41%）、26 例（43%）和 9 例（15%）中进行。所有手术均成功，无重大并发症。多变量分析显示，修订前有 3 个导联（比值比 0.444；95%置信区间 0.212-0.920；P=0.029）和先前有系统修订和导联插入（比值比 0.323；95%置信区间 0.124-0.841；P=0.021）是静脉狭窄的独立预测因素。
慢性静脉阻塞是 CIED 植入后相对常见的发现。植入的导联数量似乎是静脉阻塞的独立预测因素。在出现狭窄的情况下，术前血管造影引导的结构化方法可以保留对侧入路和功能导联。
