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. 2023 Dec 15;13(6):1068-1079.
doi: 10.21037/cdt-23-104. Epub 2023 Oct 27.

Pacemaker leads as a potential source of problems in patients who might need a central venous access port

Marek Czajkowski  1 , Anna Polewczyk  2   3 , Wojciech Jacheć  4 , Dorota Nowosielecka  5   6 , Łukasz Tułecki  6 , Paweł Stefańczyk  5 , Andrzej Kutarski  7
Affiliations

Pacemaker leads as a potential source of problems in patients who might need a central venous access port

Marek Czajkowski et al. Cardiovasc Diagn Ther. .

Abstract

Background: Lead-dependent venous occlusion may impede the insertion of a central venous access device (CVAD). The aim of this retrospective, cohort study was to assess the chance of implantation of CVAD in patients with cardiac implantable electronic devices (CIEDs).

Methods: We reviewed and analyzed 3,075 venograms of patients with CIEDs undergoing transvenous lead extraction (TLE) between June 2008 and July 2021. Relationship between venous patency and the chance of CVAD placement was estimated.

Results: In 2,318 (75.38%) patients, venography showed no potential obstacles to venous port implantation on the ipsilateral side. In patients with leads on the left side, significant narrowing more often affected the subclavian vein than the brachiocephalic vein [1,595 (55.29%) vs. 830 (28.63%), respectively] or the superior vena cava (SVC) [21 (0.73%) cases]. Furthermore, the subclavian and brachiocephalic veins on the opposite side were also narrowed [35 (2.35%) and 27 (1.24%), respectively]. The chances of port insertion were assessed as easy on CIED side or opposite side in 2,318 (75.38%) and 2,291 (97.91%) patients, respectively), as difficult insertion/questionable performance in 246 (8.00%) and 22 (0.94% patients) and doubtful or impossible insertion/questionable performance in 511 (16.62%)/27 (1.15%) patients with CIED.

Conclusions: (I) Varying degrees of lead-dependent venous obstruction (LDVO) is a frequent finding in patients with CIEDs; (II) the major thoracic veins on the opposite side of the chest may also be significantly narrowed; (III) venography should be considered before attempted CVAD insertion in patients with long lead dwell times or in patients after CIED removal, including planned contralateral port placement.

Keywords: Endocardial leads; lead-related venous obstruction; venography; venous port complications; venous port implantation.

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://cdt.amegroups.com/article/view/10.21037/cdt-23-104/coif). The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Flow chart of the study group. *, incomplete venogram of the evaluated vein was excluded from the evaluation (lack of information). TLE, transvenous lead extraction.
Figure 2
Figure 2
Four examples of difficult or even dangerous venous port insertion in spite of normal jugular vein lumen and blood flow detected by ultrasound. Brachiocephalic vein occlusion with collateral flow.
Figure 3
Figure 3
Four examples of potential obstacles during attempted venous port insertion, despite normal axillary or subclavian vein lumen and blood flow detected by ultrasound. Brachiocephalic vein occlusion.
See this image and copyright information in PMC

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