scholarly journals Central Venoplasty in Patients with Cardiac Implantable Electronic Devices

2021 ◽  
Author(s):  
Mohammed Aljarie ◽  
Mohammed Alahmari ◽  
Mohammad Arabi
Keyword(s):  
Subclavian Vein ◽  
Electronic Device ◽  
Clinical Success ◽  
Superior Vena ◽  
Vena Cava ◽  
Lead Extraction ◽  
Brachiocephalic Vein ◽  
Central Venous ◽  
Arm Swelling ◽  
Venous Angioplasty

Abstract Objective The aim of this study was to assess the safety and effectiveness of the central venous angioplasty in patients with central venous occlusion and cardiac implantable electronic device (CIED) without lead extraction. Materials and Methods A retrospective study was used to evaluate the effectiveness of 37 central venous angioplasty procedure for 15 patients with CIED without lead extraction. Results Technical success was achieved in 97% (n = 36/37) and clinical success was achieved in 89% (33/37) of the procedures. One procedure failed recanalization of chronic total occlusion of the left subclavian vein, and the patient required fistula embolization due to severe arm swelling. Another procedure failed initially to recanalize long-segment occlusion involving the right subclavian vein/brachiocephalic vein and superior vena cava in a patient with a history of Hickman line and left-sided CIED. This was successfully recanalized and angioplastied on a subsequent session. No lead fracture or dislodgment was documented in any procedure. No procedure-related complication was documented within 2 weeks after the angioplasty. Six-month primary patency was achieved in 62% (23/37) of the procedures. Ten patients (66%) required an average of 1.4 reinterventions (range: 1–4 interventions) during the follow-up time with mean time to reintervention of 318 days (5–1,380 days). Two patients required early reinterventions within 10 days due to catheter dysfunction. Conclusion Findings of this study support the existing evidence on the safety and effectiveness of balloon angioplasty without lead extraction.

The diagnostic value of multi-detector CT angiography for catheter-related central venous stenosis in hemodialysis patients

2020 ◽  
pp. 026835552095509
Author(s):  
Yuliang Zhao ◽  
Letian Yang ◽  
Yating Wang ◽  
Huawei Zhang ◽  
Tianlei Cui ◽  
...  
Keyword(s):  
Internal Jugular Vein ◽  
Superior Vena Cava ◽  
Subclavian Vein ◽  
Jugular Vein ◽  
Superior Vena ◽  
Vena Cava ◽  
Brachiocephalic Vein ◽  
Central Venous ◽  
Hemodialysis Catheter ◽  
Central Venous Stenosis

The objective is to compare Multi-detector CT angiography (MDCTA) and digital subtraction angiography (DSA) in diagnosing hemodialysis catheter related-central venous stenosis (CVS). During a period of 6 years, hemodialysis patients with suspected catheter related-CVS who received both MDCTA and DSA were retrospectively enrolled. We analyzed the sensitivity, specificity, accuracy, Cohen’s kappa coefficient (κ) and other diagnostic parameters for MDCTA compared to DSA. A total of 1533 vascular segments in 219 patients were analyzed. Among the 280 lesions identified by DSA, 156 were correctly identified by MDCTA. There were 124 false negative and 41 false positive diagnoses. MDCTA had a high specificity (96.73%) but a low sensitivity (55.71%), with a moderate inter-test agreement (κ = 0.5930). In stratified analyses of vascular segments, the specificities of MDCTA were 89.93% (superior vena cava), 98.95% (left brachiocephalic vein), 95.33% (right brachiocephalic vein), 99.53% (left subclavian vein), 97.61% (right subclavian vein), 97.13% (left internal jugular vein), and 95.86% (right internal jugular vein), while the sensitivities were 90.00%, 65.52%, 66.67%, 87.50%, 40.00%, 20.00% and 8.11%, respectively. Good to excellent inter-test agreement was observed for the superior vena cava (κ = 0.7870), left brachiocephalic vein (κ = 0.7300), right brachiocephalic vein (κ = 0.6610), and left subclavian vein (κ = 0.8700) compared with poor to low agreement for the right subclavian vein (κ = 0.3950), left internal jugular vein (κ = 0.1890), and right internal jugular vein (κ = 0.0500). MDCTA had a high specificity in diagnosing hemodialysis catheter related-CVS. Its sensitivity varied by central venous segments, with better performance in superior vena cava and brachiocephalic veins.

scholarly journals The use of laser lead extraction sheath in the presence of supra-cardiac occlusion of the central veins for cardiac implantable electronic device lead upgrade or revision

PLoS ONE ◽  
2021 ◽  
Vol 16 (5) ◽  
pp. e0251829
Author(s):  
Sameer Al-Maisary ◽  
Gabriele Romano ◽  
Matthias Karck ◽  
Raffaele De Simone ◽  
Jamila Kremer
Keyword(s):  
Superior Vena Cava ◽  
Complication Rate ◽  
Electronic Device ◽  
Superior Vena ◽  
Vena Cava ◽  
Venous Access ◽  
Left Ventricular ◽  
Right Atrial ◽  
Lead Extraction ◽  
Severe Stenosis

Background The implantation of cardiac implantable electronic devices (CIED) has increased in the last decades with improvement in the quality of life of patients with cardiac rhythm disorders. The presence of bilateral subclavian, innominate or superior vena cava obstruction is a major limitation to device revision and/or upgrade. Methods and material This is retrospective study of patients who underwent laser-assisted lead extraction (LLE) (GlideLight laser sheath, Spectranetics Corporation, Colorado Springs, USA) with lead revision or upgrade using the laser sheath as a guide rail. Patients with known occlusion, severe stenosis or functional obstruction of the venous access vessels with indwelling leads were included in this study. Results 106 patients underwent percutaneous LLE with lead revision and/or upgrade. Preoperative known complete occlusion or severe stenosis of access veins was present in 23 patients (21.5%). More patients with implantable cardioverter-defibrillator (ICD) underwent LLE (64.1%) than patients with CRT-Ds (24.5%) and pacemaker patients (11.3%). In total 172 leads were extracted: 79 (45.9%) single-coil defibrillator leads, 35 (20.3%) dual-coil defibrillator leads, 31 (18.0%) right atrial leads, 24 (13.9%) right ventricular leads and three (1.7%) malfunctional coronary sinus left ventricular pacing leads. The mean age of leads was 99.2±65.6 months. The implantation of new leads after crossing the venous stenosis/obstruction was successful in 98 (92.4%) cases. Postoperative complications were pocket hematoma in two cases and wound infection in one case. No peri-operative and no immediate postoperative death was recorded. One intraoperative superior vena cava tear was treated by immediate thoracotomy and surgical repair. Conclusion In a single-center study on LLE in the presence of supra-cardiac occlusion of the central veins for CIED lead upgrade and revision we could demonstrate a low procedural complication rate with no procedural deaths. Most of the leads could be completely extracted to revise or upgrade the system. Our study showed a low complication rate, with acceptable mortality rates.

scholarly journals Tunnelled central venous catheter–induced thrombosis: a rare case of superior vena cava syndrome

CJEM ◽  
2005 ◽  
Vol 7 (04) ◽  
pp. 273-277 ◽  
Author(s):  
Sandeep K. Aggarwal ◽  
William McCauley
Keyword(s):  
Central Venous Catheter ◽  
Superior Vena Cava ◽  
Superior Vena Cava Syndrome ◽  
Superior Vena ◽  
Vena Cava ◽  
Venous Catheter ◽  
Venous Obstruction ◽  
Central Venous ◽  
Arm Swelling ◽  
Vena Cava Syndrome

ABSTRACTThrombotic venous obstruction in patients with a tunnelled central venous catheter is a cause of superior vena cava syndrome that is not routinely encountered by emergency physicians. Diagnosis requires identifying patients at risk (e.g., those under treatment for cancer and those who have a tunnelled central venous catheter), recognizing the signs and symptoms of superior vena cava syndrome, usually dyspnea and dilated neck or thoracic veins, and imaging the venous obstruction using computer tomography or sonography. Management involves anticoagulation and local thrombolytic administration. We report the case of a 28-year-old woman who presented with a 2-day history of face, chest and bilateral arm swelling who had been receiving maintenance chemotherapy for acute lymphoblastic leukemia through a Hickman® catheter. This case demonstrates the need to be vigilant for thrombus formation in patients with long-term, indwelling central venous catheters.

scholarly journals Endovascular retrieval of two migrated stents from pulmonary artery by means of balloon catheter

2021 ◽  
Vol 5 ◽  
pp. 21
Author(s):  
Saad Saeed Alqahtani ◽  
Ahmed Kandeel Elhadad ◽  
Rusha Abdulmohsen Sarhan ◽  
Saleh Mohamed Alwaleedi
Keyword(s):  
Pulmonary Artery ◽  
Superior Vena ◽  
Balloon Catheter ◽  
Vena Cava ◽  
Brachiocephalic Vein ◽  
Central Venous ◽  
Venous Stenting ◽  
Central Venous Stenosis ◽  
Venous Stenosis ◽  
The Right

Long-term central venous catheters can be associated with central venous stenosis in up to 50% of cases. Central venous stenosis can be managed with central venous stenting which was demonstrated to restore patency and improve suboptimal results after percutaneous transluminal angioplasty. Dislodgment of venous stents into the right side of the heart or the pulmonary artery during stent deployment is one of the most feared complications of this procedure. Percutaneous removal of these migrated stents is the preferred alternative for the more invasive operative intervention, which may be very hazardous in these patients. We report an unusual case of a 52-year-old man on hemodialysis who underwent endovascular stenting to treat a tight stenosis of the right brachiocephalic vein and superior vena cava and suffered from stent migration to the left pulmonary artery, requiring removal by interventional radiologist.

Pacemaker implantation via occluded superior vena cava

2017 ◽  
Vol 4 (45) ◽  
pp. 23-25
Author(s):  
Aleksander Maciąg
Keyword(s):  
Superior Vena Cava ◽  
Subclavian Vein ◽  
Superior Vena ◽  
Pacemaker Implantation ◽  
Vena Cava ◽  
Lead Extraction ◽  
Pocket Infection ◽  
The Right ◽  
Diagnostic Catheter

The author describes the case of the superior vena cava occlusion detected during the new implantation of the pacemaker after lead extraction due to pocket infection. New electrode was implanted via the right subclavian vein. The occlusion in the superior vena cava was overcome with a guidewire (0.32 F) and a diagnostic catheter (JR2).

Micra pacemaker implant after cardiac implantable electronic device extraction: feasibility and long-term outcomes

EP Europace ◽  
2019 ◽  
Vol 21 (8) ◽  
pp. 1229-1236 ◽  
Author(s):  
Giulio Zucchelli ◽  
Valentina Barletta ◽  
Veronica Della Tommasina ◽  
Stefano Viani ◽  
Matteo Parollo ◽  
...  
Keyword(s):  
Electronic Device ◽  
Superior Vena ◽  
Vena Cava ◽  
Electrical Performance ◽  
Lead Extraction ◽  
Safe Procedure ◽  
Group 2 ◽  
Group 1

Abstract Aims We aimed at investigating the feasibility and outcome of Micra implant in patients who have previously undergone transvenous lead extraction (TLE), in comparison to naïve patients implanted with the same device. Methods and results Eighty-three patients (65 males, 78.31%; 77.27 ± 9.96 years) underwent Micra implant at our centre. The entire cohort was divided between ‘post-extraction’ (Group 1) and naïve patients (Group 2). In 23 of 83 patients (20 males, 86.96%; 73.83 ± 10.29 years), Micra was implanted after TLE. Indication to TLE was an infection in 15 patients (65.21%), leads malfunction in four (17.39%), superior vena cava syndrome in three (13.05%), and severe tricuspid regurgitation in one case (4.35%). The implant procedure was successful in all patients and no device-related events occurred at follow-up (median: 18 months; interquartile range: 1–24). No differences were observed between groups in fluoroscopy time (13.88 ± 10.98 min vs. 13.15 ± 6.64 min, P = 0.45), single device delivery (Group 1 vs. Group 2: 69.56% vs. 55%, P = 0.22), electrical performance at implant and at 12-month follow-up (Group 1 vs. Group 2: pacing threshold 0.48 ± 0.05 V/0.24 ms vs. 0.56 ± 0.25 V/0.24 ms, P = 0.70; impedance 640 ± 148.83 Ohm vs. 583.43 ± 99.7 Ohm, P = 0.27; and R wave amplitude 10.33 ± 2.88 mV vs. 12.62 ± 5.31 mV, P = 0.40). A non-apical site of implant was achievable in the majority of cases (72.3%) without differences among groups (78.26% vs. 70%; P = 0.42). Conclusion Micra implant is an effective and safe procedure in patients still requiring a ventricular pacing after TLE, with similar electrical performance and outcome compared with naïve patients at long-term follow-up.

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