Sudhakar Balijepalli G
Department of Cardiology, KIMS Hospital, Secunderabad, India.
J Innov Card Rhythm Manag. 2019 Jul 15;10(7):3738-3742. doi: 10.19102/icrm.2019.100704. eCollection 2019 Jul.
Upper-extremity venous obstruction is not an uncommon problem encountered by electrophysiologists. The placement of any catheter including pacemaker leads can cause stenosis or total obstruction. Affected patients often require balloon venoplasty to facilitate lead implantation. If the vein is unresponsive to venoplasty, stenting of the vein should be contemplated. We report a case of permanent pacemaker implantation after balloon venoplasty of the left subclavian vein and innominate vein following total occlusion in a patient with symptomatic complete heart block. There are many case reports to date in which balloon venoplasty of the subclavian vein has been performed before upgrading a single-chamber pacemaker to a DDD-mode pacemaker, cardiac resynchronization therapy device, or implantable cardioverter-defibrillator because of chronic venous occlusion secondary to a preexisting pacing lead. Balloon venoplasty to increase the diameter of a target vein or to overcome stenosis may be a technique that implanting electrophysiologists could adopt in order to achieve success in patients with more challenging anatomies.
上肢静脉阻塞是电生理学家遇到的常见问题。包括起搏器导线在内的任何导管放置都可能导致狭窄或完全阻塞。受影响的患者通常需要球囊血管成形术以利于导线植入。如果静脉对血管成形术无反应，则应考虑对静脉进行支架置入。我们报告一例有症状的完全性心脏传导阻滞患者，在左锁骨下静脉和无名静脉完全闭塞后行球囊血管成形术，随后植入永久性起搏器的病例。迄今为止，有许多病例报告，其中由于先前存在的起搏导线导致慢性静脉闭塞，在将单腔起搏器升级为双腔起搏器、心脏再同步治疗装置或植入式心律转复除颤器之前，已对锁骨下静脉进行了球囊血管成形术。球囊血管成形术以增加目标静脉直径或克服狭窄，可能是植入电生理学家为在解剖结构更具挑战性的患者中取得成功而可采用的一种技术。
