Venous Stenosis After Transvenous Lead Placement: A Study of Outcomes and Risk Factors in 212 Consecutive Patients
Venous Stenosis After Transvenous Lead Placement: A Study of Outcomes and Risk Factors in 212 Consecutive Patients
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DOI：
10.1161/jaha.115.001878
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发表时间：
2015-08-01
影响因子：
5.4
通讯作者：
Giudici, Michael C.
中科院分区：
文献类型：
--
作者：
Abu-El-Haija, Basil;Bhave, Prashant D.;Giudici, Michael C.
背景-静脉狭窄是经静脉置入导线的常见并发症，但静脉狭窄的危险因素到目前为止还没有明确的定义。方法和结果：共有212名患者(男性136名，女性76名；平均年龄69岁)接受了现有起搏或植入性心律转复除颤器系统的起搏、导线翻修或装置更新，平均自植入以来的时间为6.2年。行静脉造影术，测定狭窄百分率。研究变量包括年龄、性别、导线数量、导线直径、植入时间、绝缘材料、植入侧和抗凝剂的使用。总体而言，212名患者中有56人锁骨下静脉或无名静脉完全闭塞(26%)。植入导联的数量与静脉狭窄百分率之间存在显著的相关性(P=0.012)。作为一个独立变量，导线直径不是危险因素；然而，植入的导线直径之和越大，则预示着随后的静脉狭窄(P=0.009)。多次导线植入手术可能与静脉狭窄相关(P=0.057)。其他变量均未达到统计学意义。结论--静脉狭窄与植入导联的数量和导联直径之和之间存在显著的相关性。当与多个植入操作相结合时，静脉狭窄的发生率增加。
Background-Venous stenosis is a common complication of transvenous lead implantation, but the risk factors for venous stenosis have not been well defined to date. This study was designed to evaluate the incidence of and risk factors for venous stenosis in a large consecutive cohort.Methods and Results-A total of 212 consecutive patients (136 male, 76 female; mean age 69 years) with existing pacing or implantable cardioverter-defibrillator systems presented for generator replacement, lead revision, or device upgrade with a mean time since implantation of 6.2 years. Venograms were performed and percentage of stenosis was determined. Variables studied included age, sex, number of leads, lead diameter, implant duration, insulation material, side of implant, and anticoagulant use. Overall, 56 of 212 patients had total occlusion of the subclavian or innominate vein (26%). There was a significant association between the number of leads implanted and percentage of venous stenosis (P=0.012). Lead diameter, as an independent variable, was not a risk factor; however, greater sum of the lead diameters implanted was a predictor of subsequent venous stenosis (P=0.009). Multiple lead implant procedures may be associated with venous stenosis (P=0.057). No other variables approached statistical significance.Conclusions-A significant association exists between venous stenosis and the number of implanted leads and also the sum of the lead diameters. When combined with multiple implant procedures, the incidence of venous stenosis is increased.