Venus occlusion in the upper limbs in patients with CIDS

2018 ◽  
Vol 1 (46) ◽  
pp. 24-27
Author(s):  
Anna Jędrzejczak ◽  
Przemysław Mitkowski
Keyword(s):  
Left Atrial ◽  
Clinical Symptoms ◽  
Treatment Options ◽  
Electronic Devices ◽  
Left Ventricular ◽  
Venous Anatomy ◽  
Device Implantation ◽  
Vein Occlusion ◽  
Venous Stenosis ◽  
Vein Stenosis

Benefits of treatment with cardiological implantable electronic devices have been confirmed in numerous studies. Similarly to other treatment options this therapy is not free from complications. Among them venous stenoses and occlusions are observed. Its presence is related to impaired blood flow in the vessel as an effect of lead presence, endothelial malfunction and procoagulation. Despite vein occlusion is present in 9-11% of patients after device implantation and vein stenosis which is grater then 70% of diameter in 17-38% or even in some groups up to 50%, clinical symptoms are reported only in 1-3% of patients. What is interesting in 13,7% of individuals before implantation venous stenosis over 60% is present and occlusion in 4,4% patients. Significant venous stenosis is more frequently observed on the left side. Among risk factors responsible for stenosis one can find: numer of leads, total diameter of all leads, usage of anticoagulation and antiplatelet drugs, decreased ejection fraction, increased left ventricular end diastolic diameter, left atrial diameter, higher concentration of procoagulation and inflammatory markers. Presence of significant venous stenosis is important mainly before of up-grade procedures or lead replacement and knowledge about venous anatomy allows better planning of the subsequent procedure.

The Effect of the Cryosurgical Cox-Maze Procedure on Pulmonary Veins Diameter and Left Atrial Size

2009 ◽  
Vol 4 (4) ◽  
pp. 209-216
Author(s):  
Naama R. Bogot ◽  
Amir Elami ◽  
Dorith Shaham ◽  
Philip M. Berman ◽  
Jacob Sosna ◽  
...  
Keyword(s):  
Pulmonary Vein ◽  
Left Atrial ◽  
Statistical Significance ◽  
Pulmonary Veins ◽  
Nonparametric Test ◽  
Maze Procedure ◽  
Pulmonary Vein Stenosis ◽  
Venous Anatomy ◽  
Lesion Pattern ◽  
Vein Stenosis

Objective The Cox-Maze procedure using cryoablation results in transmural lesions, which follow the lesion pattern of the cut-and-sew Cox-Maze procedure. The purpose of our study was to evaluate the effect of the Cox-Maze procedure on left atrial and pulmonary vein size using computed tomography angiogram (CTA). An additional aim was to evaluate pulmonary vein anatomic variability. Methods Six patients (four women and two men; ages 39–63 years, mean age 54.3) underwent chest CTA 1 day before and 38 to 104 days (mean 62.6 days) after the cryosurgical Cox-Maze procedure. Measurements of pulmonary vein ostia and left atrial cranio-caudal, left-to-right and anterior-posterior diameters were derived by consensus. The change in diameters after therapy was compared using the Wilcoxon nonparametric test for paired measurements. Four patients (1 woman and 3 men; age 57–73 years; mean age 59) were evaluated with postoperative CTA alone 296–530 days (mean 447) after surgery, for the development of postoperative pulmonary vein stenosis. A single patient underwent preoperative CTA, but surgery was not performed. Pulmonary venous anatomy was recorded in all 11 patients. Results Sinus rhythm was restored in all operated patients. No focal ostial stenosis of the pulmonary veins was observed. The quantitative assessment in the six patients with preoperative and postoperative studies disclosed only slight changes in pulmonary vein diameter with either reduction or dilatation of no more than 20% from baseline (P > 0.05). There was a consistent trend toward decrease in left atrial dimensions, which did not reach statistical significance. Six patients (55%) had standard pulmonary venous anatomy and five patients (45%) had at least one variation in their pulmonary vein anatomy. Conclusions In this study, we found that a very intensive cryoablation protocol around the pulmonary veins did not result in pulmonary vein stenosis. In addition, a relatively high incidence of anatomic variations of the pulmonary veins was documented.

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