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Simpson J, Yoder M, Christian-Miller N, Wheat H, Kovacs B, Cunnane R, Ghannam M, Liang JJ. Long-Term Complications Related to Cardiac Implantable Electronic Devices. J Clin Med 2025; 14:2058. [PMID: 40142866 PMCID: PMC11942853 DOI: 10.3390/jcm14062058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2025] [Revised: 03/08/2025] [Accepted: 03/13/2025] [Indexed: 03/28/2025] Open
Abstract
Cardiac implantable electronic devices (CIEDs) are commonly used for a number of cardiac-related conditions, and it is estimated that over 300,000 CIEDs are placed annually in the US. With advances in technology surrounding these devices and expanding indications, CIEDs can remain implanted in patients for long periods of time. Although the safety profile of these devices has improved over time, both the incidence and prevalence of long-term complications are expected to increase. This review highlights pertinent long-term complications of CIEDs, including lead-related issues, device-related arrhythmias, inappropriate device therapies, and device-related infections. We also explore key clinical aspects of each complication, including common presentations, patient-specific and non-modifiable risk factors, diagnostic evaluation, and recommended management strategies. Our goal is to help spread awareness of CIED-related complications and to empower physicians to manage them effectively.
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Affiliation(s)
- Jamie Simpson
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI 48109, USA; (J.S.); (M.Y.); (N.C.-M.)
| | - Mason Yoder
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI 48109, USA; (J.S.); (M.Y.); (N.C.-M.)
| | - Nathaniel Christian-Miller
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI 48109, USA; (J.S.); (M.Y.); (N.C.-M.)
| | - Heather Wheat
- Department of Clinical Electrophysiology, Frankel Cardiovascular Center, University of Michigan, Ann Arbor, MI 48109, USA; (H.W.); (B.K.); (R.C.); (M.G.)
| | - Boldizsar Kovacs
- Department of Clinical Electrophysiology, Frankel Cardiovascular Center, University of Michigan, Ann Arbor, MI 48109, USA; (H.W.); (B.K.); (R.C.); (M.G.)
| | - Ryan Cunnane
- Department of Clinical Electrophysiology, Frankel Cardiovascular Center, University of Michigan, Ann Arbor, MI 48109, USA; (H.W.); (B.K.); (R.C.); (M.G.)
| | - Michael Ghannam
- Department of Clinical Electrophysiology, Frankel Cardiovascular Center, University of Michigan, Ann Arbor, MI 48109, USA; (H.W.); (B.K.); (R.C.); (M.G.)
| | - Jackson J. Liang
- Department of Clinical Electrophysiology, Frankel Cardiovascular Center, University of Michigan, Ann Arbor, MI 48109, USA; (H.W.); (B.K.); (R.C.); (M.G.)
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López-Rubio M, Lago-Rodríguez MO, Ordieres-Ortega L, Oblitas CM, Moragón-Ledesma S, Alonso-Beato R, Alvarez-Sala-Walther LA, Galeano-Valle F. A Comprehensive Review of Catheter-Related Thrombosis. J Clin Med 2024; 13:7818. [PMID: 39768741 PMCID: PMC11728333 DOI: 10.3390/jcm13247818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2024] [Revised: 12/18/2024] [Accepted: 12/19/2024] [Indexed: 01/16/2025] Open
Abstract
Catheter-related thrombosis (CRT) is a frequent and potentially serious complication associated with the widespread use of intravascular devices such as central venous catheters, including peripherally inserted central catheters and implantable port systems, pacemakers or implantable cardioverter-defibrillators. Although CRT management has been informed by guidelines extrapolated from lower extremity deep vein thrombosis (DVT), unique challenges remain due to the distinct anatomical, pathophysiological, and clinical characteristics of upper extremity DVT. Risk factors for CRT are multifactorial, encompassing patient-related characteristics such as cancer, prior venous thromboembolism, and infection, as well as catheter-specific factors like device type, lumens, and insertion site. The diagnosis of CRT relies primarily on ultrasonography; however, computed tomography angiography and magnetic resonance imaging play a complementary role, particularly in anatomically challenging cases or when complications such as pulmonary embolism or superior vena cava syndrome are suspected. Treatment strategies for CRT include anticoagulation, catheter removal when feasible, and, in select cases, local thrombolysis or catheter-directed interventions. Anticoagulation remains the cornerstone of therapy, with direct oral anticoagulants increasingly favored due to their safety profile and efficacy. This article provides a detailed review of CRT, focusing on clinical features, diagnostic methods, and treatment strategies while addressing specific challenges in managing pacemaker and hemodialysis catheter-related thrombosis.
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Affiliation(s)
- Marina López-Rubio
- Venous Thromboembolism Unit, Internal Medicine Department, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain; (M.L.-R.); (L.O.-O.); (C.-M.O.); (S.M.-L.); (R.A.-B.); (L.-A.A.-S.-W.); (F.G.-V.)
- School of Medicine, Universidad Complutense de Madrid, 28040 Madrid, Spain
- Sanitary Research Institute Gregorio Marañón, 28009 Madrid, Spain
| | - Marta-Olimpia Lago-Rodríguez
- Venous Thromboembolism Unit, Internal Medicine Department, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain; (M.L.-R.); (L.O.-O.); (C.-M.O.); (S.M.-L.); (R.A.-B.); (L.-A.A.-S.-W.); (F.G.-V.)
- School of Medicine, Universidad Complutense de Madrid, 28040 Madrid, Spain
- Sanitary Research Institute Gregorio Marañón, 28009 Madrid, Spain
| | - Lucía Ordieres-Ortega
- Venous Thromboembolism Unit, Internal Medicine Department, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain; (M.L.-R.); (L.O.-O.); (C.-M.O.); (S.M.-L.); (R.A.-B.); (L.-A.A.-S.-W.); (F.G.-V.)
- School of Medicine, Universidad Complutense de Madrid, 28040 Madrid, Spain
- Sanitary Research Institute Gregorio Marañón, 28009 Madrid, Spain
| | - Crhistian-Mario Oblitas
- Venous Thromboembolism Unit, Internal Medicine Department, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain; (M.L.-R.); (L.O.-O.); (C.-M.O.); (S.M.-L.); (R.A.-B.); (L.-A.A.-S.-W.); (F.G.-V.)
- School of Medicine, Universidad Complutense de Madrid, 28040 Madrid, Spain
| | - Sergio Moragón-Ledesma
- Venous Thromboembolism Unit, Internal Medicine Department, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain; (M.L.-R.); (L.O.-O.); (C.-M.O.); (S.M.-L.); (R.A.-B.); (L.-A.A.-S.-W.); (F.G.-V.)
- School of Medicine, Universidad Complutense de Madrid, 28040 Madrid, Spain
- Sanitary Research Institute Gregorio Marañón, 28009 Madrid, Spain
| | - Rubén Alonso-Beato
- Venous Thromboembolism Unit, Internal Medicine Department, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain; (M.L.-R.); (L.O.-O.); (C.-M.O.); (S.M.-L.); (R.A.-B.); (L.-A.A.-S.-W.); (F.G.-V.)
- School of Medicine, Universidad Complutense de Madrid, 28040 Madrid, Spain
- Sanitary Research Institute Gregorio Marañón, 28009 Madrid, Spain
| | - Luis-Antonio Alvarez-Sala-Walther
- Venous Thromboembolism Unit, Internal Medicine Department, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain; (M.L.-R.); (L.O.-O.); (C.-M.O.); (S.M.-L.); (R.A.-B.); (L.-A.A.-S.-W.); (F.G.-V.)
- School of Medicine, Universidad Complutense de Madrid, 28040 Madrid, Spain
- Sanitary Research Institute Gregorio Marañón, 28009 Madrid, Spain
| | - Francisco Galeano-Valle
- Venous Thromboembolism Unit, Internal Medicine Department, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain; (M.L.-R.); (L.O.-O.); (C.-M.O.); (S.M.-L.); (R.A.-B.); (L.-A.A.-S.-W.); (F.G.-V.)
- School of Medicine, Universidad Complutense de Madrid, 28040 Madrid, Spain
- Sanitary Research Institute Gregorio Marañón, 28009 Madrid, Spain
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Wen J, Xiong S, Tu Z, Lin P, Yuan Y, Fu W, Qiu J. Which is the safer option for adult patients between peripherally inserted central catheters and midline catheters: a meta-analysis. Infect Control Hosp Epidemiol 2024:1-8. [PMID: 39533820 DOI: 10.1017/ice.2024.190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2024]
Abstract
BACKGROUND Peripherally inserted central catheters (PICC) and midline catheters (MC) are widely used for intravenous infusions in oncology and critically ill patients. However, controversy remains regarding which method is superior. This meta-analysis systematically compares the safety differences between these 2 methods of intravenous catheterization. METHODS Eligible studies comparing PICC and MC were identified through searches in 6 databases. Thrombosis is the primary endpoint, while secondary endpoints include other complications, cost, and satisfaction rate. RESULTS Fourteen studies with 20,675 patients were analyzed. Based on patient data, the MC group exhibited higher rates of catheter-related superficial vein thrombosis (SVT) (risk ratio [RR]: 0.42 [0.28, 0.64]), infiltrations (RR: 0.27 [0.12, 0.62]), and leaks (RR: 0.16 [0.05, 0.53]). In contrast, the PICC group had more catheter-related bloodstream infections (RR: 1.95 [1.15, 3.32]). Considering catheter days, the MC group showed increased total complications (RR: 0.51 [0.26, 0.99]), catheter-related thrombosis (deep vein thrombosis [DVT]+SVT) (RR: 0.41 [0.18, 0.95]), and leaks (RR: 0.17 [0.05, 0.64]). In the PICC group, the top 3 complications were catheter occlusions (20 per 1,000 catheter days [CDs]), pain (15 per 1,000 CDs), and phlebitis (11 per 1,000 CDs); for the MC group, they were leaks (33 per 1,000 CDs), premature removals (22 per 1,000 CDs), and catheter-related DVT (22 per 1,000 CDs). Additionally, the PICC group had higher dissatisfaction rates (RR: 4.77 [2.33, 9.77]) and increased costs. CONCLUSIONS Compared to MC, PICC appears to be a safer intravenous catheterization option for adult patients, exhibiting fewer complications. However, the higher associated costs and lower satisfaction rates of PICC warrant serious attention.
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Affiliation(s)
- Jianyun Wen
- Department of Head and Neck Oncology Radiation Therapy, Jiangxi Cancer Hospital, Jiangxi, China
| | - Shuping Xiong
- Department of Head and Neck Oncology Radiation Therapy, Jiangxi Cancer Hospital, Jiangxi, China
| | - Ziwei Tu
- Department of Head and Neck Oncology Radiation Therapy, Jiangxi Cancer Hospital, Jiangxi, China
| | - Ping Lin
- Department of Head and Neck Oncology Radiation Therapy, Jiangxi Cancer Hospital, Jiangxi, China
| | - Yeqin Yuan
- Department of Head and Neck Oncology Radiation Therapy, Jiangxi Cancer Hospital, Jiangxi, China
| | - Wenhong Fu
- Department of Head and Neck Oncology Radiation Therapy, Jiangxi Cancer Hospital, Jiangxi, China
| | - Juan Qiu
- Department of Head and Neck Oncology Radiation Therapy, Jiangxi Cancer Hospital, Jiangxi, China
- Department of Thoracic Oncology Radiation Therapy, Jiangxi Cancer Hospital, Jiangxi, China
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Leung P, Lui B, Wang J, Ho P, Lim HY. A 12-Year Review of Upper Extremity Deep Vein Thrombosis-Are They the Same as Lower Extremity Deep Vein Thrombosis? J Clin Med 2024; 13:6440. [PMID: 39518579 PMCID: PMC11545990 DOI: 10.3390/jcm13216440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2024] [Revised: 10/16/2024] [Accepted: 10/25/2024] [Indexed: 11/16/2024] Open
Abstract
Background: Upper extremity deep vein thrombosis (UEDVT) is uncommon but not insignificant. The current literature is limited, and the management is largely extrapolated from the treatment of lower extremity DVTs (LEDVT). Methods: A retrospective review was conducted on patients diagnosed with UEDVT at Northern Health, Victoria, Australia, between December 2010 and December 2022. Medical records were reviewed to assess baseline characteristics and treatment outcomes. The results were compared to our previously collected data for LEDVTs. Results: 137 patients with UEDVT were identified (52.6% females; median age 62 years, IQR 46-74 years). A total of 105 patients (76.6%) had at least one provoking factor at the time of diagnosis, most commonly malignancy (45.7%) and/or indwelling venous devices (58.1%). Fourteen patients (10.1%) were subsequently diagnosed with Paget-Schroetter syndrome, with nine receiving endovascular or surgical intervention. A total of 109 patients (79.6%) received limited therapeutic anticoagulation (median 3 months, IQR 1.5-6.0 months) with enoxaparin, the most common anticoagulant used. Six patients had major bleeding (5.2/100-patient-years), and seven developed clot progression while on anticoagulation (6.0/100-patient-years). Ten patients had recurrent VTE following anticoagulation cessation (4.6/100-patient-years). There were no significant differences seen in the complication rate between catheter-related UEDVT and other UEDVTs. Compared to LEDVT, UEDVT was more likely provoked with comparable complication rates. Conclusions: UEDVTs were commonly associated with a provoking factor, with indwelling catheters and/or malignancies being the most common. Interestingly, catheter-related UEDVT had comparable clot progression/recurrence and major bleeding compared to other UEDVTs and LEDVTs, which may be confounded by relatively high rates of malignancy.
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Affiliation(s)
- Patrick Leung
- Department of Haematology, Northern Hospital, Epping, VIC 3076, Australia (H.Y.L.)
| | - Brandon Lui
- Department of Haematology, Northern Hospital, Epping, VIC 3076, Australia (H.Y.L.)
| | - Julie Wang
- Department of Haematology, Northern Hospital, Epping, VIC 3076, Australia (H.Y.L.)
- Northern Clinical Diagnostics and Thrombovascular Research (NECTAR) Centre, Northern Health, Epping, VIC 3076, Australia
| | - Prahlad Ho
- Department of Haematology, Northern Hospital, Epping, VIC 3076, Australia (H.Y.L.)
- Northern Clinical Diagnostics and Thrombovascular Research (NECTAR) Centre, Northern Health, Epping, VIC 3076, Australia
- Department of Medicine (Northern Health), University of Melbourne, Epping, VIC 3076, Australia
| | - Hui Yin Lim
- Department of Haematology, Northern Hospital, Epping, VIC 3076, Australia (H.Y.L.)
- Northern Clinical Diagnostics and Thrombovascular Research (NECTAR) Centre, Northern Health, Epping, VIC 3076, Australia
- Department of Medicine (Northern Health), University of Melbourne, Epping, VIC 3076, Australia
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5
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Lago-Rodríguez MO, López-Rubio M, Moragón-Ledesma S, Oblitas CM, Galeano-Valle F, Atienza F, Carta A, Demelo-Rodríguez P. Incidence and long-term outcomes of upper limb deep vein thrombosis associated with intracardiac devices: analysis of bleeding, recurrence, and sequelae. Intern Emerg Med 2024; 19:1959-1966. [PMID: 39112732 DOI: 10.1007/s11739-024-03710-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Accepted: 07/10/2024] [Indexed: 10/11/2024]
Abstract
Pacemakers (PM) and implantable cardioverter-defibrillators are vital devices in contemporary clinical practice, but their growing adoption poses challenges. Complications, including lead migration, infections, and post-implantation venous thrombosis, underscore the importance of comprehensive investigation. This retrospective observational study enrolled patients diagnosed with upper limb deep vein thrombosis (DVT) secondary to intracardiac devices at a tertiary hospital from 2015 to 2022. The aim of the study was to determine the incidence and long-term outcomes (bleeding, DVT recurrence and sequelae) in these patients. Across the study period, 2681 intracardiac devices were implanted, with 12 cases of upper limb DVT documented. The majority of patients were male (91.7%), with a mean age of 63.92 years. DVT occurred in patients with PM (50%), implantable cardioverter-defibrillators (25%) and implantable cardioverter-defibrillators with Cardiac Resynchronization Therapy (25%). Treatment encompassed low-molecular-weight heparin (91.7%) during the acute episode and long-term anticoagulation with direct oral anticoagulants (75%) or vitamin K antagonists (25%). Over a mean follow-up period of 33.17 months, half of the patients exhibited long-term sequelae, notably collateral circulation (66.7%). Remarkably, no thrombosis recurrences were observed during follow-up. However, one patient (8.3%) experienced a major bleeding event during treatment, and one patient (8.3%) required device removal (PM) due to persistent symptoms. This study revealed upper limb DVT occurred in 0.45% of patients after intracardiac device implantation. Rate of thrombosis recurrence was low during follow-up. Although half of the patients developed long-term sequelae, the need for prolonged anticoagulant therapy in these cases remains uncertain.
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Affiliation(s)
| | - Marina López-Rubio
- Venous Thromboembolism Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
| | - Sergio Moragón-Ledesma
- Venous Thromboembolism Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
- Sanitary Research Institute Gregorio Marañón, Madrid, Spain
| | - Crhistian-Mario Oblitas
- Venous Thromboembolism Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
- Sanitary Research Institute Gregorio Marañón, Madrid, Spain
| | - Francisco Galeano-Valle
- Venous Thromboembolism Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
- Sanitary Research Institute Gregorio Marañón, Madrid, Spain
| | - Felipe Atienza
- School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
- Sanitary Research Institute Gregorio Marañón, Madrid, Spain
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Alejandro Carta
- Sanitary Research Institute Gregorio Marañón, Madrid, Spain
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Pablo Demelo-Rodríguez
- Venous Thromboembolism Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
- Sanitary Research Institute Gregorio Marañón, Madrid, Spain
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Rahmani G, O'Sullivan GJ. Acute and chronic venous occlusion. Br J Radiol 2023; 96:20230242. [PMID: 37750946 PMCID: PMC10607425 DOI: 10.1259/bjr.20230242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 06/04/2023] [Accepted: 08/04/2023] [Indexed: 09/27/2023] Open
Abstract
This review article provides an overview of acute and chronic venous occlusion, a condition that can cause significant morbidity and mortality if not diagnosed and treated promptly. The article begins with an introduction to the anatomy of the venous system, followed by a discussion of the causes and clinical features of venous occlusion. The diagnostic tools available for the assessment of venous occlusion, including imaging modalities such as ultrasound, CT, and MRI, are then discussed, along with their respective advantages and limitations. The article also covers the treatment options for acute and chronic venous occlusion, including anticoagulant therapy and endovascular interventions. This review aims to provide radiologists with an updated understanding of the pathophysiology, diagnosis, and management of acute and chronic venous occlusion.
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Affiliation(s)
- George Rahmani
- Department of Interventional Radiology, Galway University Hospitals, Galway, Ireland
| | - Gerard J O'Sullivan
- Department of Interventional Radiology, Galway University Hospitals, Galway, Ireland
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7
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Jagadish A, Paladugula A, Thakkar A, Das D. A Case of Multiple Vein Thrombosis Following Pacemaker Implantation. Cureus 2023; 15:e47466. [PMID: 38022209 PMCID: PMC10662435 DOI: 10.7759/cureus.47466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2023] [Indexed: 12/01/2023] Open
Abstract
Pacemakers are implanted as part of the treatment process of conditions including symptomatic bradycardia and certain types of heart block. One complication associated with pacemaker implantation is upper extremity deep venous thrombosis (UEDVT), which can subsequently lead to pulmonary embolism, limb loss, or death. We present the case of an 88-year-old male who developed UEDVT in his left subclavian, axillary, brachial, and basilic veins shortly after dual chamber pacemaker implantation for treating symptomatic heart block. The patient received anticoagulation with intravenous heparin while inpatient but was switched to oral apixaban prior to discharge. This case highlights the importance of detecting and treating UEDVT in patients who recently underwent pacemaker placement.
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Affiliation(s)
- Ashwin Jagadish
- Internal Medicine, East Tennessee State University James H. Quillen College of Medicine, Johnson City, USA
| | - Abhijith Paladugula
- Internal Medicine, East Tennessee State University James H. Quillen College of Medicine, Johnson City, USA
| | - Aditya Thakkar
- Internal Medicine, East Tennessee State University James H. Quillen College of Medicine, Johnson City, USA
| | - Debalina Das
- Internal Medicine, East Tennessee State University James H. Quillen College of Medicine, Johnson City, USA
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8
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Núñez Fernández MJ, Padín Paz EM, Vázquez Temprano N, Nieto Rodríguez JA, Marchena Yglesias PJ, Imbalzano E, Montenegro AC, Fernández Jiménez B, Rivera A, Espitia O, Monreal M. Risk for recurrence of symptomatic upper-extremity deep vein thrombosis in patients without cancer: Analysis of three RIETE cohorts. Vasc Med 2023; 28:324-330. [PMID: 37272085 DOI: 10.1177/1358863x231175185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND The natural history of patients with a pacemaker-related upper-extremity deep vein thrombosis (UEDVT) has not been consistently studied. METHODS We used the RIETE registry data to compare the outcomes during anticoagulation and after its discontinuation in noncancer patients with symptomatic UEDVT associated with a pacemaker, other catheters, or no catheter. The major outcome was the composite of symptomatic pulmonary embolism or recurrent DVT. RESULTS As of February 2022, 2578 patients with UEDVT were included: 156 had a pacemaker-related UEDVT, 557 had other catheters, and 1865 had no catheter. During anticoagulation, 61 patients (2.3%) developed recurrent VTE, 38 had major bleeding (1.4%), and 90 died (3.4%). After its discontinuation, 52 patients (4.4%) had recurrent acute venous thromboembolism (VTE) and six had major bleeding (0.5%). On multivariable analysis, there were no differences among subgroups in the rates of VTE recurrences or major bleeding during anticoagulation. After its discontinuation, patients with a pacemaker-related UEDVT had a higher risk for VTE recurrences than those with no catheter (adjusted OR: 4.59; 95% CI: 1.98-10.6). CONCLUSIONS Patients with pacemaker-related UEDVT are at increased risk for VTE recurrences after discontinuing anticoagulation. If our findings are validated in adequately designed trials, this may justify changes in the current recommendations on the duration of anticoagulation.
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Affiliation(s)
- Manuel J Núñez Fernández
- Department of Internal Medicine, Complejo Hospitalario Universitario de Pontevedra, Pontevedra, Spain
| | - Emilio M Padín Paz
- Department of Internal Medicine, Complejo Hospitalario Universitario de Pontevedra, Pontevedra, Spain
| | - Nuria Vázquez Temprano
- Department of Internal Medicine, Complejo Hospitalario Universitario de Pontevedra, Pontevedra, Spain
| | - José A Nieto Rodríguez
- Department of Internal Medicine, Hospital General Virgen de la Luz, Cuenca, Castilla-La Mancha, Spain
| | - Pablo J Marchena Yglesias
- Department of Internal Medicine and Emergency, Parc Sanitari Sant Joan de Déu-Hospital General, Barcelona, Spain
| | - Egidio Imbalzano
- Department of Clinical and Experimental Medicine, A.O.U Policlinico 'G. Martino', Messina, Italy
| | - Ana Cristina Montenegro
- Department of Vascular Medicine, Hospital Universitario Fundacion Santa Fe de Bogotá, Bogotá, Colombia
| | | | - Alberto Rivera
- Department of Internal Medicine, Hospital Álvaro Cunqueiro, Vigo, Pontevedra, Spain
| | - Olivier Espitia
- Centre Hospitalier Universitaire de Nantes, Service de Médecine Interne, Nantes, Pays de la Loire, France
| | - Manuel Monreal
- Chair for the Study of Thromboembolic Disease, Faculty of Health Sciences, UCAM - Universidad Católica San Antonio de Murcia, Barcelona, Spain
- CIBER Enfermedades Respiratorias (CIBERES), Madrid, Spain
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9
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Singh O, Juneja D. Upper extremity deep vein thrombosis: An intensivist's perspective. World J Crit Care Med 2023; 12:130-138. [PMID: 37397592 PMCID: PMC10308337 DOI: 10.5492/wjccm.v12.i3.130] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 03/16/2023] [Accepted: 04/20/2023] [Indexed: 06/08/2023] Open
Abstract
Upper extremity deep vein thrombosis (UEDVT) is less common than lower extremity DVT but is a cause of significant morbidity and mortality in intensive care unit patients. Increasing cancer incidence, prolonged life expectancy and increasing use of intravascular catheters and devices has led to an increased incidence of UEDVT. It is also associated with high rates of complications like pulmonary embolism, post-thrombotic syndrome and recurrent thrombosis. Clinical prediction scores and D-dimer may not be as useful in identifying UEDVT; hence, a high suspicion index is required for diagnosis. Doppler ultrasound is commonly employed for diagnosis, but other tests like computed tomography and magnetic resonance imaging venography may also be required in some patients. Contrast venography is rarely used in patients with clinical and ultrasound findings discrepancies. Anticoagulant therapy alone is sufficient in most patients, and thrombolysis and surgical decompression is seldom indicated. The outcome depends on the cause and underlying comorbidities.
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Affiliation(s)
- Omender Singh
- Institute of Critical Care Medicine, Max Super Speciality Hospital, Saket, New Delhi 110017, India
| | - Deven Juneja
- Institute of Critical Care Medicine, Max Super Speciality Hospital, Saket, New Delhi 110017, India
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10
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Ferro EG, Kramer DB, Li S, Locke AH, Misra S, Schmaier AA, Carroll BJ, Song Y, D'Avila AA, Yeh RW, Zimetbaum PJ, Secemsky EA. Incidence, Treatment, and Outcomes of Symptomatic Device Lead-Related Venous Obstruction. J Am Coll Cardiol 2023:S0735-1097(23)05427-X. [PMID: 37204378 DOI: 10.1016/j.jacc.2023.04.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 04/06/2023] [Indexed: 05/20/2023]
Abstract
BACKGROUND The incidence and clinical impact of lead-related venous obstruction (LRVO) among patients with cardiovascular implantable electronic devices (CIEDs) is poorly defined. OBJECTIVES The objectives of this study were to determine the incidence of symptomatic LRVO after CIED implant; describe patterns in CIED extraction and revascularization; and quantify LRVO-related health care utilization based on each type of intervention. METHODS LRVO status was defined among Medicare beneficiaries after CIED implant from October 1, 2015, to December 31, 2020. Cumulative incidence functions of LRVO were estimated by Fine-Gray methods. LRVO predictors were identified using Cox regression. Incidence rates for LRVO-related health care visits were calculated with Poisson models. RESULTS Among 649,524 patients who underwent CIED implant, 28,214 developed LRVO, with 5.0% cumulative incidence at maximum follow-up of 5.2 years. Independent predictors of LRVO included CIEDs with >1 lead (HR: 1.09; 95% CI: 1.07-1.15), chronic kidney disease (HR: 1.17; 95% CI: 1.14-1.20), and malignancies (HR: 1.23; 95% CI: 1.20-1.27). Most patients with LRVO (85.2%) were managed conservatively. Among 4,186 (14.8%) patients undergoing intervention, 74.0% underwent CIED extraction and 26.0% percutaneous revascularization. Notably, 90% of the patients did not receive another CIED after extraction, with low use (2.2%) of leadless pacemakers. In adjusted models, extraction was associated with significant reductions in LRVO-related health care utilization (adjusted rate ratio: 0.58; 95% CI: 0.52-0.66) compared with conservative management. CONCLUSIONS In a large nationwide sample, the incidence of LRVO was substantial, affecting 1 of every 20 patients with CIEDs. Device extraction was the most common intervention and was associated with long-term reduction in recurrent health care utilization.
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Affiliation(s)
- Enrico G Ferro
- Richard A. and Susan F. Smith Center for Outcomes Research, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA; Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Daniel B Kramer
- Richard A. and Susan F. Smith Center for Outcomes Research, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA; Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Siling Li
- Richard A. and Susan F. Smith Center for Outcomes Research, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Andrew H Locke
- Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Shantum Misra
- Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Alec A Schmaier
- Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Brett J Carroll
- Richard A. and Susan F. Smith Center for Outcomes Research, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA; Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Yang Song
- Richard A. and Susan F. Smith Center for Outcomes Research, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Andre A D'Avila
- Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Robert W Yeh
- Richard A. and Susan F. Smith Center for Outcomes Research, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA; Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Peter J Zimetbaum
- Richard A. and Susan F. Smith Center for Outcomes Research, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA; Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
| | - Eric A Secemsky
- Richard A. and Susan F. Smith Center for Outcomes Research, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA; Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
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Koethe Y, Bochnakova T, Kaufman CS. Upper Extremity Deep Venous Thrombosis: Etiologies, Diagnosis, and Updates in Therapeutic Strategies. Semin Intervent Radiol 2022; 39:475-482. [PMID: 36561939 PMCID: PMC9767760 DOI: 10.1055/s-0042-1757937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Upper extremity deep vein thrombosis (UEDVT) is responsible for 4 to 10% of all deep vein thrombosis (DVT). Untreated UEDVT can lead to significant disability secondary to the postthrombotic syndrome. To date, there are no randomized trials specifically comparing different therapeutic strategies. Ultimately, optimal management of UEDVT depends on the underlying etiology, patient symptoms, and degree of thrombosis, with supporting evidence primarily extrapolated from lower extremity DVT data. This article will review the classification, presentation, and diagnosis of both primary and secondary UEDVT. In addition, it will discuss updates in clinical guidelines, anticoagulation, endovascular and surgical treatment strategies.
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Affiliation(s)
- Yilun Koethe
- Dotter Department of Interventional Radiology, Oregon Health & Sciences University, Portland, Oregon
| | - Teodora Bochnakova
- Dotter Department of Interventional Radiology, Oregon Health & Sciences University, Portland, Oregon
| | - Claire S Kaufman
- Dotter Department of Interventional Radiology, Oregon Health & Sciences University, Portland, Oregon
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12
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Ivanov Y, Buratto E, Schulz A, Konstantinov IE. Commentary: From little things big things grow. JTCVS Tech 2022; 11:36. [PMID: 35169730 PMCID: PMC8828921 DOI: 10.1016/j.xjtc.2021.10.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 10/19/2021] [Accepted: 10/26/2021] [Indexed: 11/18/2022] Open
Affiliation(s)
- Yaroslav Ivanov
- Department of Cardiac Surgery, Royal Children's Hospital, Melbourne, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Edward Buratto
- Department of Cardiac Surgery, Royal Children's Hospital, Melbourne, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
- Heart Research Group, Murdoch Children's Research Institute, Melbourne, Australia
| | - Antonia Schulz
- Department of Cardiac Surgery, Royal Children's Hospital, Melbourne, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Igor E. Konstantinov
- Department of Cardiac Surgery, Royal Children's Hospital, Melbourne, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
- Heart Research Group, Murdoch Children's Research Institute, Melbourne, Australia
- Melbourne Centre for Cardiovascular Genomics and Regenerative Medicine, Melbourne, Australia
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