Abstract
Objective: One of the late-onset complications of cardiac implanted electronic devices (CIEDs) is central venous obstruction (CVO). The aim of this study was to investigate the feasibility, efficacy, and safety of endovascular treatment of CIED-related CVOs.Methods:Eighteen patients who underwent endovascular management of their device-related CVO were reviewed. Patients were classified into three groups: Group I patients were asymptomatic and needed lead replacement; Group II patients presented with symptomatic CVO without lead dysfunction, and Group III patients were referred with both symptomatic CVO and lead dysfunction. A treatment strategy involved recanalization and balloon angioplasty for Group I and angioplasty/stents for Groups II and III. Technical success, clinical success, complications, and long-term follow-up were assessed.Results: Thirteen patients were in Group I, four in Group II, and one in Group III. Technical and clinical success was achieved in 17 patients (94%). No major complications were reported. Restenosis was observed in two patients at 40 and 42 weeks of follow-up, and these patients were successfully treated with angioplasty.Conclusion: Endovascular management of CVO due to CIED is a safe and efficient technique. Plain balloon angioplasty is sufficient for lead replacement purposes, while stenting is needed for symptomatic CVO to achieve good long-term patency.
Highlights
Since their introduction in 1960s, transvenous cardiac implanted electronic devices (CIED) continue to provide obvious benefits for the management cardiac rhythm disorders and heart failure [1]
We reviewed all patients with history of a CIED, who were referred to the Radiology department for Central venous obstruction (CVO) from February 2005 to April 2016
They have been classified into three groups based on the presence of symptoms and/or CIED dysfunction as follows: 1) Group I: Patients were asymptomatic, but it was suspected that they had CVOs due to the failure of pacemaker lead extraction and/or upgrade or because of a failure to insert a peripheral central line
Summary
Since their introduction in 1960s, transvenous cardiac implanted electronic devices (CIED) (which include pacemakers, cardioverter-defibrillators, and cardiac resynchronization therapies) continue to provide obvious benefits for the management cardiac rhythm disorders and heart failure [1]. They are, associated with such complications as device dislodgement, perforation, infection, migration, and vein stenosis or thrombosis [2]. With the growing number of CIED implantations, complication prevention, and management are a crucial clinical issue. Central venous obstruction (CVO) is the most important complication. The reported incidence of CVO after CIED implantation varies widely [3].
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