Albertini CMDM, Silva KRD, Leal Filho JMDM, Crevelari ES, Martinelli Filho M, Carnevale FC, Costa R. Usefulness of preoperative venography in patients with cardiac implantable electronic devices submitted to lead replacement or device upgrade procedures.
Arq Bras Cardiol 2018;
111:686-696. [PMID:
30281686 PMCID:
PMC6248256 DOI:
10.5935/abc.20180164]
[Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Accepted: 06/12/2018] [Indexed: 01/06/2023] Open
Abstract
Background
Venous obstructions are common in patients with transvenous cardiac
implantable electronic devices, but they rarely cause immediate clinical
problems. The main consequence of these lesions is the difficulty in
obtaining venous access for additional leads implantation.
Objectives
We aimed to assess the prevalence and predictor factors of venous lesions in
patients referred to lead reoperations, and to define the role of
preoperative venography in the planning of these procedures.
Methods
From April 2013 to July 2016, contrast venography was performed in 100
patients referred to device upgrade, revision and lead extraction. Venous
lesions were classified as non-significant (< 50%), moderate stenosis
(51-70%), severe stenosis (71-99%) or occlusion (100%). Collateral
circulation was classified as absent, discrete, moderate or accentuated. The
surgical strategy was defined according to the result of the preoperative
venography. Univariate analysis was used to investigate predictor factors
related to the occurrence of these lesions, with 5% of significance
level.
Results
Moderate venous stenosis was observed in 23%, severe in 13% and occlusions in
11%. There were no significant differences in relation to the device side or
the venous segment. The usefulness of the preoperative venography to define
the operative tactic was proven, and in 99% of the cases, the established
surgical strategy could be performed according to plan.
Conclusions
The prevalence of venous obstruction is high in CIED recipients referred to
reoperations. Venography is highly indicated as a preoperative examination
for allowing the adequate surgical planning of procedures involving previous
transvenous leads.
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