Stojanovic Nikola, Ukenenye Emmanuel, Syed Asma
Medicine, Brookdale University Hospital and Medical Center, Brooklyn, USA.
Internal Medicine, Brookdale University Hospital and Medical Center, Brooklyn, USA.
Cureus. 2024 Jul 9;16(7):e64145. doi: 10.7759/cureus.64145. eCollection 2024 Jul.
The brachiocephalic vein (BCV), also known as the innominate vein, is a central vein in the upper chest formed by merging the internal jugular and subclavian veins. It plays a crucial role in venous return from the head, neck, and upper extremities and is significant in procedures such as pacemaker and implantable cardioverter-defibrillator (ICD) placement, chemotherapy ports, and central venous catheter insertions. The presence of foreign bodies and local malignancy are major risk factors for thrombosis in the BCV. As part of the deep venous system, BCV thrombosis (BCVT) is a rare condition but can lead to serious complications like superior vena cava syndrome and, rarely, pulmonary embolism. This case report presents an 82-year-old woman with a history of heart failure with reduced ejection fraction, coronary artery disease, atrial fibrillation, HIV, pulmonary embolism, systemic lupus erythematosus, and breast cancer who required an ICD placement due to persistent systolic dysfunction. During the procedure, chronic BCVT leading to the stenosis was incidentally discovered, necessitating urgent vascular intervention to establish venous patency. The patient's complex medical history, including previous chemotherapy through a central venous catheter, contributed to the risk factors for BCVT. The multidisciplinary approach led to successful ICD placement and the reinstatement of anticoagulation therapy. This case underscores the rarity and severity of BCVT and highlights the importance of pre-procedural imaging, such as CT venography, in patients with multiple risk factors. Additionally, the report suggests considering leadless ICD technology for patients with limited venous access to avoid complications. The findings emphasize the critical need for thorough evaluation and planning in complex cases to ensure successful outcomes.
头臂静脉（BCV），也称为无名静脉，是上胸部的一条中央静脉，由颈内静脉和锁骨下静脉汇合而成。它在头部、颈部和上肢的静脉回流中起着关键作用，在诸如起搏器和植入式心脏复律除颤器（ICD）植入、化疗端口和中心静脉导管插入等操作中具有重要意义。异物的存在和局部恶性肿瘤是头臂静脉血栓形成的主要危险因素。作为深静脉系统的一部分，头臂静脉血栓形成（BCVT）是一种罕见的病症，但可导致诸如上腔静脉综合征等严重并发症，且很少会引发肺栓塞。本病例报告介绍了一名82岁女性，有射血分数降低的心力衰竭、冠状动脉疾病、心房颤动、HIV、肺栓塞、系统性红斑狼疮和乳腺癌病史，因持续性收缩功能障碍需要植入ICD。在手术过程中，偶然发现导致狭窄的慢性BCVT，需要紧急进行血管干预以建立静脉通畅。患者复杂的病史，包括先前通过中心静脉导管进行化疗，促成了BCVT的危险因素。多学科方法导致ICD成功植入并恢复抗凝治疗。本病例强调了BCVT的罕见性和严重性，并突出了术前成像（如CT静脉造影）在具有多种危险因素的患者中的重要性。此外，该报告建议对于静脉通路有限的患者考虑使用无导线ICD技术以避免并发症。这些发现强调了在复杂病例中进行全面评估和规划以确保成功结果的迫切需要。
