Venoplasty to gain venous access during cardiac device implantation is feasible and safe

Abstract

Abstract Funding Acknowledgements Type of funding sources: None. Background Venous obstruction is relatively common after cardiac implantable electronic device (CIED) implantation. After CIED implantation 15% of the patients present with a severe or total occlusion. This poses a problem during lead revisions or upgrades often leading to implantation failure or complex extraction or lead tunneling procedures. Percutaneous balloon venoplasty might be a suitable option but is rarely performed. Purpose To identify the feasibility and safety of venoplasty during cardiac device implantation procedures. Methods We retrospectively included consecutive cardiac device implantations in which venoplasty was performed during the same procedure from December 2018 until December 2020. The venoplasty was done either planned or ad hoc, by an interventional radiologist. Results We included 17 patients, 14 (82%) were male, aged 73 ± 11 years. Fifteen (88%) patients required an upgrade or lead revision and two were de novo implantations. The subclavian vein was the site of occlusion in 13 (76%) patients. In 16 (94%) patients venoplasty was successful and all intended leads could be implanted subsequently. In the patient with the unsuccessful recanalization both an antegrade and retrograde approach via the vena femoralis was attempted. No venoplasty related complications occurred. The figure shows a succesful upgrade from a single chamber ICD (panel A) to a CRT-D (panel D) after venoplasty for a total occulsion of the vena subclavia (panel B and C). Conclusions Percutaneous balloon venoplasty is a safe and feasible method for patients in whom venous access is an issue during CIED implantation. This method can be performed ad hoc and prevents contralateral lead implantation with tunneling or lead extraction. Abstract Figure. Venoplasty during upgrade.