Coronary artery bypass grafting with internal thoracic arteries may cause bilateral brachiocephalic vein occlusion,...

Area of Science:

• Cardiology
• Vascular Surgery
• Medical Imaging

Background:

• Increasing prevalence of arrhythmia and ischemic heart disease necessitates pacemaker implantation.
• Brachiocephalic vein occlusion is a known complication post-pacemaker implantation, but its association with prior coronary artery bypass grafting (CABG) is less understood.
• Internal thoracic artery grafts are commonly used in CABG, yet their long-term impact on central venous pathways requires further investigation.

Observation:

• A case of failed percutaneous pacemaker implantation is presented in a patient with bilateral brachiocephalic vein occlusion.
• The occlusion occurred 8 years after undergoing bilateral internal thoracic artery coronary artery bypass grafting.
• Rich collateral venous networks, including the hemiazygos and azygos veins, were noted.

Findings:

• Percutaneous pacemaker implantation was unsuccessful due to complete bilateral brachiocephalic vein occlusion.
• Surgical pacemaker implantation provided a viable alternative in this complex venous anatomy.
• The findings suggest a potential link between bilateral internal thoracic artery usage in CABG and subsequent central venous complications.

Implications:

• This case underscores the importance of considering prior CABG, especially with bilateral internal thoracic artery grafts, when evaluating central venous access for pacemaker implantation.
• Enhanced imaging modalities like contrast CT or venography may be crucial for pre-procedural assessment in such patients.
• Further research is warranted to elucidate the mechanisms and long-term consequences of brachiocephalic vein occlusion following CABG with internal thoracic artery grafts.