Yousuf Qayoom, Rashid Aamir, Hafeez Imran, Rather Hilal, Syed Ishrath, Mir Altaf H, Mir Suheel A, Lone Ajaz
Department of Cardiology, SKIMS Soura, Srinagar, J&K, India.
Department of Medicine, SKIMS Soura, Srinagar, J&K, India.
J Saudi Heart Assoc. 2023 Nov 25;35(4):301-310. doi: 10.37616/2212-5043.1358. eCollection 2023.
Very few studies have been done on Venous stenosis following the first transvenous cardiac device implantation. We aimed to assess the prevalence and predictors of Venous stenosis/Occlusion following the first transvenous cardiac device implantation with venous angiography at one year of follow-up.
This study was a single-center prospective, observational study. Demographic, clinical, procedural, and device data was collected. All patients underwent a preimplant contrast and repeated venography at twelve months to look for upper limb venous anatomy, obstruction, or collaterals.
A total of 146 patients were included in the final analysis. 60 (41 %) patients developed some degree of venous stenosis. Most patients had mild to moderate stenosis, and almost all were asymptomatic. Among patient-related factors increasing age (64.66 ± 10.07 vs 60.91 ± 11.94 years p = 0.04), presence of hypertension (50.5 % vs 19.6 % p = 0.0004), diabetes (73 % vs 29.6 % p = 0.000) and dyslipidemia (66.7 % vs 36.3 p = 0.009) were significantly associated with Venous stenosis/occlusion. Among procedure-related factors, larger total lead diameter (3.88 ± 1.09 vs. 3.50 ± 1.03 mm p = 0.03) and implantation of biventricular devices (p = 0.0037) seem to be significantly associated with venous obstruction. In logistic regression analysis, hypertension (p = 0.018), total lead diameter (p = 0.024), and use of CRT-P/CRTD/ICD (p = 0.03) remained significant predictors of severe venous stenosis.
Our study demonstrates venous obstruction in 40 % of cardiac implantable electronic device patients at one-year follow-up. Most patients have mild to moderate stenosis, and almost all are asymptomatic. Increasing age, hypertension, diabetes, dyslipidemia, larger total lead diameter, and implantation of biventricular devices are significantly associated with venous obstruction.
关于首次经静脉植入心脏装置后发生静脉狭窄的研究极少。我们旨在通过随访一年时的静脉血管造影评估首次经静脉植入心脏装置后静脉狭窄/闭塞的发生率及预测因素。
本研究为单中心前瞻性观察性研究。收集了人口统计学、临床、手术及装置数据。所有患者在植入前进行造影，并在十二个月时重复进行静脉造影，以观察上肢静脉解剖结构、阻塞情况或侧支循环。
共有146例患者纳入最终分析。60例（41%）患者出现了一定程度的静脉狭窄。大多数患者为轻度至中度狭窄，且几乎所有患者均无症状。在患者相关因素中，年龄增加（64.66±10.07岁对60.91±11.94岁，p = 0.04）、存在高血压（50.5%对19.6%，p = 0.0004）、糖尿病（73%对29.6%，p = 0.000）和血脂异常（66.7%对36.3%，p = 0.009）与静脉狭窄/闭塞显著相关。在手术相关因素中，总导线直径较大（3.88±1.09毫米对3.50±1.03毫米，p = 0.03）和双心室装置植入（p = 0.0037）似乎与静脉阻塞显著相关。在逻辑回归分析中，高血压（p = 0.018）、总导线直径（p = 0.024）和CRT-P/CRTD/ICD的使用（p = 0.03）仍然是严重静脉狭窄的显著预测因素。
我们的研究表明，在随访一年时，40%的心脏植入式电子装置患者存在静脉阻塞。大多数患者为轻度至中度狭窄，且几乎所有患者均无症状。年龄增加、高血压、糖尿病、血脂异常、总导线直径较大和双心室装置植入与静脉阻塞显著相关。
