ABSTRACT
BACKGROUND: The need to add a lead(s) despite subclavian/innominate obstruction is increasing. Subclavian venoplasty may be a good alternative to the commonly employed options; however, there are few reports in the literature, and all are by interventional radiologists. OBJECTIVE: To describe the procedural details, results and safety of venoplasty by implanting physicians in a large group of consecutive patients. METHODS: Safety, lead function and success were established from review of the procedure reports and clinical complications in 373 consecutive venoplasty patients from 1999-2010. Procedural details were obtained by review of the angiograms (venograms) and procedural flow charts of 152 consecutive patients from 2004-2007. RESULTS: Venoplasty was successful in 371 of 373 patients without damage to the existing leads and without clinical complications. Total angiographic occlusion was demonstrated in 65% of cases by peripheral venogram, but in only 20% of cases by contrast injection at the site of obstruction; 86% were crossed with a hydrophilic wire. Microdissection and excimer laser were used to cross three of the four wire-refractory occlusions. Obstruction was both central and peripheral in 22.1% of cases and central only in 17%. The time required to cross the obstruction and perform venoplasty was 13 ± 21 minutes. A noncompliant balloon was successful in most, but an ultranoncompliant balloon was required in 13% of cases. Contrast extravasation was common during crossing of a total obstruction and also was observed with balloon rupture on three occasions, but was not clinically significant. CONCLUSIONS: Subclavian venoplasty is a safe, practical lead-management option that can be used by implanting physicians.
Subject(s)
Catheterization/methods , Electrodes, Implanted/adverse effects , Subclavian Vein/surgery , Venous Thrombosis/surgery , Adult , Aged , Aged, 80 and over , Equipment Failure , Female , Follow-Up Studies , Humans , Male , Middle Aged , Phlebography , Retrospective Studies , Subclavian Vein/diagnostic imaging , Time Factors , Venous Thrombosis/diagnostic imaging , Venous Thrombosis/etiologyABSTRACT
Coronary venous anatomy can make successful implantation of a cardiac resynchronization therapy device difficult or impossible. Venogram and coronary balloons can be used as anchors to facilitate initial coronary sinus (CS) cannulation and left ventricular lead placement and to recover lost CS and target vein access.
Subject(s)
Angioplasty, Balloon , Cardiac Pacing, Artificial , Coronary Sinus , Coronary Vessels/anatomy & histology , Heart Ventricles , Catheterization/methods , Coronary Vessel Anomalies/therapy , Electrodes, Implanted , Ergonomics , Humans , Ventricular Dysfunction, Left/therapyABSTRACT
A persistent left superior vena cava markedly increases the size of the coronary sinus (CS), which can increase the difficulty of left ventricular (LV) lead placement in patients receiving cardiac resynchronization therapy (CRT). We present a case where the entire superior vena cava drains into the coronary sinus, creating a massive CS. We also describe an interventional approach to LV lead implantation utilizing a combination of delivery systems from different vendors.
Subject(s)
Bundle-Branch Block/complications , Bundle-Branch Block/prevention & control , Coronary Vessel Anomalies/complications , Defibrillators, Implantable , Electrodes, Implanted , Prosthesis Implantation/methods , Vena Cava, Superior/abnormalities , Aged , Humans , MaleABSTRACT
Patients with existing internal cardioverter defibrillators (ICDs) often require upgrading to a biventricular ICD for treatment of congestive heart failure. Placement of a left ventricular (LV) lead can be technically challenging in the best of circumstances. A subclavian vein stenosis or occlusion related to previously placed leads adds a major obstacle to a successful implant. We report a technique to implant an LV lead from the same side as the existing ICD system despite failed microdissection of a complete occlusion of the subclavian vein.
Subject(s)
Defibrillators, Implantable , Electrodes, Implanted , Heart Failure/therapy , Subclavian Vein , Aged , Equipment Design , Fluoroscopy , Heart Failure/physiopathology , Humans , Male , Needles , PhlebographyABSTRACT
Patients with existing internal cardioverter defibrillators (ICDs) often require upgrading to a biventricular ICD for treatment of congestive heart failure (CHF). Placement of a left ventricular (LV) lead can be technically challenging in the best of circumstances. A subclavian vein stenosis or occlusion related to previously placed leads adds a major obstacle to a successful implant. We report a technique of implanting an LV lead from the same side as the existing ICD system despite complete occlusion of the subclavian vein.
