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[Percutaneous venoplasty for the implantation of a dual-chamber cardiac pacemaker]
J A Trigano1, M Poncet, P Lauribe
1Service de cardiologie, CHU Nord, Marseille.
Insights
Percutaneous venous recanalization successfully treated severe brachiocephalic vein stenosis during pacemaker reoperation. This approach preserved venous access for new pacing leads, ensuring continued cardiac pacing.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Surgery
Background:
- Venous obstruction in the subclavian or brachiocephalic vein can complicate reoperations for cardiac pacing device implantation.
- Previous attempts at catheterization may lead to stenosis or occlusion, necessitating alternative approaches.
- Maintaining venous access is crucial for the longevity and efficacy of cardiac pacing systems.
Observation:
- During reoperation for pacemaker implantation, obstruction was encountered during catheterization of the homolateral subclavian vein at the brachiocephalic vein.
- Severe brachiocephalic vein stenosis was identified as the cause of obstruction.
- The existing ventricular pacing wire was successfully isolated and preserved.
Findings:
- Balloon angioplasty via the femoral vein successfully treated the severe brachiocephalic vein stenosis.
- Following angioplasty, repeat subclavian venous catheterization allowed for the uncomplicated introduction of two new pacing wires.
- The femoral vein approach provided direct access to the dilatation site, minimizing infectious risk.
Implications:
- Percutaneous venous recanalization is a viable and effective technique for managing venous stenosis during cardiac pacing reoperations.
- This method preserves venous capital, allowing for future interventions and ensuring the continued function of cardiac pacing.
- The femoral vein approach offers a safe and direct alternative when homolateral venous access is compromised.
Abstract:
During reoperation for pacemaker implantation, venous catheterisation of the homolateral subclavian vein encountered obstruction at the brachiocephalic vein. Balloon angioplasty of the severe brachiocephalic stenosis was performed via the femoral vein. After repeat subclavian venous catheterisation two new pacing wires could be introduced without difficulty followed by active fixation in the atrium and passive fixation in the ventricular apex. The initial ventricular pacing wire was isolated and respected. The femoral vein approach gave simple and direct access to the site of dilatation at a distance to the operative field which was shielded from an infectious risk. The technique and results of percutaneous venous recanalisation have not been extensively analysed during reoperation for cardiac pacing. In chronic cardiac pacing, the success of homolateral operation despite venous occlusion or stenosis, ensures preservation of the venous capital.