Hybrid venous recanalization and cardiac implantable electronic device lead revision procedures: A single-center retrospective analysis of 38 patients.

PURPOSE: The purpose of this study was to describe the safety and efficacy of hybrid recanalization procedures in a series of patients with obstructed central veins requiring cardiac implantable electronic device (CIED) revision. METHODS: Between 2008 and 2016, 38 consecutive patients (24 M; age 60.5 ±â€¯16.2 years; range 25-87 years) with central venous obstruction underwent 42 recanalization interventions performed in conjunction with CIED revision or extraction. Fifty percent of patients (19/38) presented with veno-occlusive symptoms, and 13% (5/38) of patients had CIED leads with an ipsilateral upper extremity dialysis conduit. RESULTS: Ninety-one percent (38/42) of all procedures resulted in successful recanalization and CIED revision. Twenty-four percent (9/38) of all patients required secondary procedures due to recurrent stenosis, and 78% (7/9) of those requiring secondary procedures had indwelling dialysis conduits and/or clinical symptoms related to venous occlusion before the initial procedure. There were complications in 2 patients related to recanalization, and in 3 related to CIED revision. CONCLUSIONS: Recanalization of central venous stenosis/occlusion in patients with CIED can be technically challenging but is successful in most patients. Symptomatic patients and those with dialysis conduits often require more aggressive revascularization interventions and may be at increased risk of complication or need for secondary interventions.

Hypertensive goals in patients with coronary artery disease.

There are many prospective clinical trials that have examined cardiovascular outcomes over the past 2 decades. Trials completed within the last 5 years clearly indicate that overall cardiovascular risk is reduced by blood pressure lowering to levels below 140/90 mm Hg. Greater cardiovascular risk reduction is not seen, however, by driving blood pressure to levels well below 130/80 mm Hg. This is true across the spectrum of cardio-renal risk with few exceptions, stroke prevention possibly being one. Further there should be an awareness that outcome studies performed within the last decade will not have the same risk reduction of a given class of antihypertensive drug previously tested. This is primarily due to an improved standard of care that was not present in trials of a decade ago and thus, more recent trials have lower cardiovascular risk at baseline. Lastly, new guidelines will most likely change the goal blood pressure to <140/90 mm Hg as all data support this level. Lastly, the caution of lowering diastolic blood pressure below 60 mm Hg especially in the elderly must be avoided to minimize reductions in coronary perfusion.