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Venous System Interventions for Device Implantation.

Jose M Marcial1, Seth J Worley1

  • 1Department of Medicine, Division of Cardiology, Cardiac Arrhythmia Center, Medstar Heart and Vascular Institute, Medstar Washington Hospital Center, 110 Irving Street Northwest, Washington, DC 20010, USA.

Cardiac Electrophysiology Clinics
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Summary
This summary is machine-generated.

Subclavian venoplasty (SV) effectively treats venous obstructions after lead implantation, improving access quality and preserving future options. This procedure enhances catheter manipulation for complex pacing lead placements.

Keywords:
BiventricularFocused force venoplastyHis pacingOcclusionStenosisSubclavian occlusionUpgradeVenoplasty

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Area of Science:

  • Cardiovascular Medicine
  • Interventional Cardiology
  • Medical Device Technology

Background:

  • Subclavian vein obstruction is a frequent complication following pacemaker or defibrillator lead implantation.
  • The increasing prevalence of lead revisions and additions necessitates effective management of venous access.
  • Existing venous occlusions can impede the successful implantation of new or replacement cardiac leads.

Purpose of the Study:

  • To evaluate the safety and efficacy of subclavian venoplasty (SV) as a treatment for venous obstructions.
  • To compare the outcomes of SV with traditional methods like dilators for managing venous access.
  • To assess the impact of SV on the quality of venous access for cardiac lead implantation.

Main Methods:

  • Peripheral venography was utilized to assess venous obstruction severity.
  • Subclavian venoplasty (SV) was performed using guidewire access to the central circulation.
  • Catheter manipulation capabilities were evaluated post-SV compared to dilator use.

Main Results:

  • Peripheral venography tends to overestimate the degree of subclavian venous obstruction.
  • SV successfully restored adequate venous caliber, allowing for unimpeded catheter movement.
  • SV improved the quality of venous access, facilitating His bundle and left ventricular lead implantation.
  • The procedure preserved existing venous access and reduced the overall lead burden.

Conclusions:

  • Subclavian venoplasty is a safe and effective intervention for managing venous obstructions post-lead implantation.
  • SV offers superior venous access quality compared to simple dilation, enabling complex lead procedures.
  • Integrating SV into lead management strategies preserves venous access and minimizes lead-related complications.