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Vasoconstrictive responses of the cephalic vein during first-time cardiac implantable electronic device placement
R Steckiewicz1, E B Świętoń, M Bogdańska
1Department of Cardiology, Medical University of Warsaw, Poland, Banacha 1a, Warsaw, Poland. r.steckiewicz@pro.onet.pl.
Insights
Cephalic vein vasoconstriction is a rare complication during cardiac device implantation. This phenomenon, observed during lead insertion, was limited by vein valves and sometimes required a change in surgical approach.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Vascular Biology
Background:
- Cardiac implantable electronic device (CIED) implantation often involves transvenous lead insertion.
- Vessel injury during CIED procedures can trigger reflex vasoconstriction.
- The incidence of cephalic vein (CV) vasoconstriction during initial CIED implantation is not well-established.
Purpose of the Study:
- To determine the incidence of cephalic vein vasoconstriction during first-time CIED implantation.
- To analyze the impact of CV vasoconstriction on lead insertion procedures.
- To investigate the histological characteristics of the constricted cephalic vein.
Main Methods:
- Retrospective analysis of 146 first-time CIED implantation procedures from 2016.
- Inclusion of cases with documented CV vasoconstriction via venography.
- Focus on lead insertion stages involving CV cutdown and/or axillary/subclavian vein puncture.
Main Results:
- Vasoconstriction was observed in 11 patients (7.5%).
- The phenomenon occurred during lead insertion, necessitating approach changes in severe cases.
- Histological findings showed altered myocyte arrangement in the tunica media at valve attachments.
Conclusions:
- Cephalic vein vasoconstriction is a rare complication during first-time CIED implantation.
- Vasoconstriction propagation was limited by adjacent venous valves.
- Histological changes suggest a potential mechanism for this vascular response.
Background:
During cardiac implantable electronic device (CIED) implantation procedures cardiac leads have been mostly introduced transvenously. The associated injury to the selected vessel and adjacent tissues may induce reflex vasoconstriction. The aim of the study was to assess the incidence of cephalic vein (CV) vasoconstriction during first-time CIED implantation.
Materials And Methods:
Of the 146 evaluated first-time CIED implantation procedures conducted in our centre in 2016, we selected those during which CV vasoconstriction was recorded. We focused on the stage of the procedure involving CV cutdown and/or axillary vein (AV)/subclavian vein (SV) puncture for lead insertion. Only cases documented via venography were considered.
Results:
Vasoconstriction was observed in 11 patients (5 females and 6 males, mean age 59.0 ± 21.2 years). The presence of this phenomenon affected the stage of CIED implantation involving cardiac lead insertion to the venous system, in severe cases, requiring a change of approach from CV cutdown to AV/SV puncture. The extent of vasoconstriction front propagation was limited to the nearest valves. Histological examinations of collected CV samples revealed an altered spatial arrangement of myocytes in the tunica media at the level of leaflet attachment.
Conclusions:
Cephalic vein vasoconstriction is a rare phenomenon associated with accessing the venous system during first-time CIED implantation. The propagation of CV constriction was limited by the location of the nearest valves.
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