Lokalne zaburzenie drożności lewej żyły ramienno-głowowej podczas cyklu oddechowego przez potencjalny czynnik inicjacji zmian pozakrzepowych po zabiegach implantacji wszczepialnego urządzenia do elektroterapii serca czy wprowadzeniu cewnika do żyły centralnej

Abstract

Introduction. The left brachiocephalic vein (LBCV) courses between the sternum and the aortic arch (or its main branches). Anomalous spatial positioning of the LBCV and these adjacent anatomical structures may result in LBCV compression. Such circumstances result in a narrowing or complete occlusion of this vein, which may affect the course of intravascular procedures, such as cardiac implantable electronic device (CIED) or central venous catheter (CVC) placement. This increases the risk of venous injury and/or the subsequent occlusion due to thrombus formation. Material and methods. Out of 2,112 de novo CIED implantation procedures performed in the period 2014–2019, 391 cases required intraoperative venography to identify the cause of difficulties in endovascular lead advancement. Venography data from these cases were analysed and only those cases were included for further analysis where the cause of difficulties was shown to be LBCV compression, further exacerbated on expiration. Results. Severe localized LBCV compression affecting the course of CIED implantation procedures was detected in 12 patients (8 women and 4 men, aged 80 ± 7 years). Such localized venous compression was observed mainly at the level where the brachiocephalic trunk and the left common carotid artery branch of the aortic arch. Conclusions. The analysed data showed the phenomenon of localized, respiration-related LBCV compression, which became exacerbated on expiration, in 3% of the analysed de novo CIED implantation procedures. This phenomenon may be associated with increased long-term thrombotic venous occlusion in the vascular segments containing cardiac leads or CVCs.