When and how to perform venoplasty for lead placement

Area of Science:

• Cardiology
• Interventional Cardiology
• Medical Device Technology

Background:

• Increasing use of cardiac implantable electronic devices (CIEDs) leads to a rise in lead failures.
• CIED upgrades are common for therapies like cardiac resynchronization therapy.
• Venous obstruction affects 10-20% of patients post-CIED, hindering new lead placement.

Purpose of the Study:

• To describe a step-by-step approach for preprocedural venoplasty.
• To present venoplasty as a safe and effective solution for venous obstruction in CIED patients.
• To facilitate ipsilateral venous access for new lead implantation.

Main Methods:

• Detailed procedural description of preprocedural venoplasty.
• Focus on techniques applicable in interventional catheterization laboratories.
• Emphasis on achieving safe and successful ipsilateral venous access.

Main Results:

• Preprocedural venoplasty is associated with the lowest short- and long-term risks.
• The described technique can be safely performed in most interventional settings.
• Successful ipsilateral venous access is achieved, enabling new lead implantation.

Conclusions:

• Preprocedural venoplasty is a viable and low-risk solution for managing venous obstruction in CIED patients.
• This technique addresses a significant obstacle for CIED upgrades and lead replacement.
• Interventional catheterization laboratories are well-equipped to implement this procedure.