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Upper Extremity Deep Vein Thrombosis and Asymptomatic Vein Occlusion in Patients With Transvenous Leads: A Systematic

Daniël Duijzer1, Maria A de Winter2, Mathilde Nijkeuter2

  • 1Department of Vascular Medicine, University Medical Center Utrecht, Utrecht, Netherlands.

Frontiers in Cardiovascular Medicine
|September 7, 2021
PubMed

Insights

Transvenous leads increase the risk of upper extremity deep vein thrombosis (UEDVT), occurring years after implantation. Asymptomatic vein occlusion is also common, complicating future lead procedures.

Area of Science:

  • Cardiology
  • Vascular Medicine
  • Medical Device Research

Background:

  • Transvenous leads for cardiac device therapy are associated with venous thromboembolism risk.
  • Systematic epidemiological data on these complications, specifically upper extremity deep vein thrombosis (UEDVT) and asymptomatic vein occlusion, are lacking.

Approach:

  • A systematic literature search of PubMed, EMBASE, and Cochrane Library was conducted up to March 31, 2020.
  • Pooled estimates for the incidence of symptomatic UEDVT and prevalence of asymptomatic vein occlusion were calculated from identified studies.
  • Meta-regression was used to explore associations between lead number and UEDVT risk.

Key Points:

  • The pooled incidence of symptomatic UEDVT was 0.9 per 100 patient-years, with high heterogeneity and limited low-risk-of-bias studies.
  • The pooled prevalence of asymptomatic upper extremity vein occlusion was 8.6%, also with significant heterogeneity.
  • Increased number of leads was associated with a higher risk of UEDVT.

Conclusions:

  • Transvenous leads are a significant risk factor for symptomatic UEDVT, which can manifest years post-implantation.
  • Existing research on UEDVT following lead implantation is largely of poor quality, necessitating high-quality prospective studies.
  • A substantial proportion of patients exhibit asymptomatic vein occlusion, potentially complicating future lead interventions.

Keywords:
cardiac device therapydeep vein thrombosisepidemiologysystematic review and meta-analysistransvenous leads

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