Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Aug 18:8:698336.
doi: 10.3389/fcvm.2021.698336. eCollection 2021.

Upper Extremity Deep Vein Thrombosis and Asymptomatic Vein Occlusion in Patients With Transvenous Leads: A Systematic Review and Meta-Analysis

Daniël Duijzer  1 , Maria A de Winter  2 , Mathilde Nijkeuter  2 , Anton E Tuinenburg  3 , Jan Westerink  1
Affiliations

Upper Extremity Deep Vein Thrombosis and Asymptomatic Vein Occlusion in Patients With Transvenous Leads: A Systematic Review and Meta-Analysis

Daniël Duijzer et al. Front Cardiovasc Med. .

Abstract

Aims: The presence of transvenous leads for cardiac device therapy may increase the risk of venous thromboembolisms. The epidemiology of these complications has not yet been determined systematically. Therefore, this study aims to determine (I) the incidence of symptomatic upper extremity deep vein thrombosis (UEDVT) and (II) the prevalence of asymptomatic upper extremity vein occlusion in patients with transvenous leads, both after the initial 2 months following lead implantation. Methods: PubMed, EMBASE, and Cochrane Library were searched until March 31, 2020 to identify studies reporting incidence of UEDVT and prevalence of asymptomatic vein occlusion after the initial 2 months after implantation in adult patients with transvenous leads. Incidence per 100 patient years of follow-up (PY) and proportions (%) were calculated to derive pooled estimates of incidence and prevalence. Results: Search and selection yielded 20 and 24 studies reporting on UEDVT and asymptomatic vein occlusion, respectively. The overall pooled incidence of UEDVT was 0.9 (95% CI 0.5-1.4) per 100PY after 2 months after lead implantation. High statistical heterogeneity was present among studies (I2 = 82.4%; P = < 0.001) and only three studies considered to be at low risk of bias. The overall pooled prevalence of asymptomatic upper extremity vein occlusion was 8.6% (95% CI 6.0-11.5) with high heterogeneity (I2 = 81.4%; P = <0.001). Meta-regression analysis showed more leads to be associated with a higher risk of UEDVT. Conclusion: Transvenous leads are an important risk factor for symptomatic UEDVT, which may occur up to multiple years after initial lead implantation. Existing data on UEDVT after lead implantation is mostly of poor quality, which emphasizes the need for high quality prospective research. Asymptomatic vein occlusion is present in a substantial proportion of patients and may complicate any future lead addition. Clinical Trial Registration: (URL: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020178136, Identifier: PROSPERO 2020 CRD42020178136).

Keywords: cardiac device therapy; deep vein thrombosis; epidemiology; systematic review and meta-analysis; transvenous leads.

PubMed Disclaimer

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Flow diagram of study selection process for meta-analysis.
Figure 2
Figure 2
Meta-analysis of incidence rate of UEDVT. CI, confidence interval; PY, patient years; UEDVT, upper extremity deep vein thrombosis.
Figure 3
Figure 3
Funnel plot of the included studies for the incidence rate of UEDVT. UEDVT, upper extremity deep vein thrombosis.
Figure 4
Figure 4
Meta-analysis of the prevalence of asymptomatic upper extremity vein occlusion.
Figure 5
Figure 5
Funnel plot of the included studies for the prevalence of asymptomatic vein occlusion.
See this image and copyright information in PMC

References

    1. Raatikainen MJP, Arnar DO, Zeppenfeld K, Merino JL, Levya F, Hindriks G, et al. . Statistics on the use of cardiac electronic devices and electrophysiological procedures in the European Society of Cardiology countries: 2014 report from the European Heart Rhythm Association. Europace. (2015) 17(Suppl. 1):i1–75. 10.1093/europace/euu300 - DOI - PubMed
    1. Bradshaw PJ, Stobie P, Knuiman MW, Briffa TG, Hobbs MST. Trends in the incidence and prevalence of cardiac pacemaker insertions in an ageing population. Open Heart. (2014) 1:e000177. 10.1136/openhrt-2014-000177 - DOI - PMC - PubMed
    1. Uslan DZ, Tleyjeh IM, Baddour LM, Friedman PA, Jenkins SM, St Sauver JL, et al. . Temporal trends in permanent pacemaker implantation: a population-based study. Am Heart J. (2008) 155:896–903. 10.1016/j.ahj.2007.12.022 - DOI - PMC - PubMed
    1. Donnelly J, Gabriels J, Galmer A, Willner J, Beldner S, Epstein LM, et al. . Venous obstruction in cardiac rhythm device therapy. Curr Treat Options Cardiovasc Med. (2018) 20:64. 10.1007/s11936-018-0664-5 - DOI - PubMed
    1. Levy MM, Albuquerque F, Pfeifer JD. Low incidence of pulmonary embolism associated with upper-extremity deep venous thrombosis. Ann Vasc Surg. (2012) 7:964–72. 10.1016/j.avsg.2011.12.016 - DOI - PubMed

Publication types

LinkOut - more resources