*Corresponding Author: Vanita Arora, Department of Cardiac Sciences, Indraprastha Apollo Hospital, New Delhi, India.

Received: August 24, 2021; Published: September 24, 2021

Citation: Vanita Arora., et al.. “A Simple Venoplasty to Place the Lead in Occluded Venous Access". Acta Scientific Clinical Case Reports 5.10 (2021): 20-22.

Abstract

  Pacemakers and cardiac defibrillators are an essential life-saving implantable devices with more than 600,000 implantations each year. There are more than 3 million people worldwide with pacemakers and the number of these device implants increases with each passing year. As of 2016, it was estimated that there were about 1.14 million pacemakers globally and by the year 2023 that number is expected to increase to 1.43 million units.

  The venous approach is the most common method used for permanent pacemaker lead implantation because of its ease and safety and the various veins used are the subclavian, cephalic (cut down) and axillary veins. Venous thrombosis and stenosis at the implantation site are probably more common than previously thought of because most patients remain asymptomatic due to the adjoining bridging venous collateral formation and the condition remains undetected. Variable incidence has been reported in the literature, but up to 50% of patients may develop at least moderate subclavian vein stenosis, defined in most studies as a greater than 50% luminal narrowing by contrast venography. 

  Despite the increasing use of pacemakers and implantable cardiac defibrillators, a lack of understanding remains with regard to the risk factors for development of these device-associated venous obstructions. The shear wall stress, adjoining blood flow velocity, blood pressure and the stasis at the implantation site are all the risk factors for increasing the propensity of thrombus formation and subsequent venous occlusion. 

  An awareness of the venous complications of transvenous cardiac pacing is important because prompt diagnosis and therapy may decrease the potential morbidity and mortality. Various management strategies have been employed, including anticoagulation, lead extraction, percutaneous venoplasty with or without stenting, tunnelling and epicardial lead surgery. However, no consensus regarding the optimal treatment of this problem exists and there is limited evidence to support the success and safety of one approach over another. Venoplasty is one of the simplest and safest approach to overcome venous obstruction during pacemaker/ICD lead implantation.

Keywords: Venoplasty; Occluded Venous Access; Pacemakers; Cardiac Defibrillators

Bibliography

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2. Majid H., et al. “Predictors of venous obstruction following pacemaker or implantable cardioverter-defibrillator implantation: a contrast venographic study on 100 patients admitted for generator change, lead revision, or device upgrade”. EP Europace 5 (2007): 328-332.
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Copyright: © 2021 Vanita Arora., et al.. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.