Subclavian venoplasty by the implanting physicians in 373 patients over 11 years
Subclavian venoplasty by the implanting physicians in 373 patients over 11 years
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DOI：
10.1016/j.hrthm.2010.12.014
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发表时间：
2011-04-01
期刊：
影响因子：
5.5
通讯作者：
Tuzi, Joann
中科院分区：
文献类型：
--
作者：
Worley, Seth Joseph;Gohn, Douglas Charles;Tuzi, Joann
背景尽管锁骨下/无名动脉阻塞，但添加电极导线的需求正在增加。锁骨下静脉成形术可能是一个很好的替代常用的选择;然而，在文献中的报道很少，而且都是由介入放射科医生进行的。目的描述由植入医生在大量连续患者中进行静脉成形术的操作细节、结果和安全性。方法安全性，通过审查1999-2010年373例连续静脉成形术患者的手术报告和临床并发症，确定了电极导线功能和成功率。通过回顾2004- 2007年152例连续患者的血管造影（静脉造影）和手术流程图获得手术细节。结果373例患者中371例静脉成形术成功，未损坏现有电极导线，无临床并发症。通过外周静脉造影，65%的病例显示血管造影完全闭塞，但通过在阻塞部位注射造影剂，仅20%的病例显示血管造影完全闭塞; 86%的病例使用亲水性导丝穿过。使用显微切割和准分子激光穿过四个金属丝难治性闭塞中的三个。22.1%的病例阻塞为中央和外周阻塞，17%仅为中央阻塞。穿过梗阻并进行静脉成形术所需的时间为13 ± 21分钟。非顺应性球囊在大多数情况下是成功的，但在13%的病例中需要超顺应性球囊。造影剂外渗是常见的，在穿越的总阻塞，也观察到与球囊破裂的三个场合，但没有临床显着的CONCLUSIONS锁骨下静脉成形术是一种安全，实用的铅管理的选择，可用于植入医生。
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.