Incidence of venous obstruction following insertion of an implantable cardioverter defibrillator.: A study of systematic contrast venography on patients presenting for their first elective ICD generator replacement
Incidence of venous obstruction following insertion of an implantable cardioverter defibrillator.: A study of systematic contrast venography on patients presenting for their first elective ICD generator replacement
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DOI：
10.1016/j.eupc.2003.09.001
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发表时间：
2004-01-01
期刊：
影响因子：
6.1
通讯作者：
Lüderitz, B
中科院分区：
文献类型：
--
作者：
Lickfett, L;Bitzen, A;Lüderitz, B
目标 植入式心律转复除颤器 (10) 植入数量以及发电机更换、导联修正和导联系统升级等后续程序的数量不断增加。导线修正和额外导线的植入需要在先前 ICD 植入部位建立静脉通路。因此，我们研究的目的是评估慢性经静脉 ICD 系统植入后静脉阻塞的发生率。方法和结果 纳入了 105 名连续入院接受首次选择性 ICD 发生器更换的患者。所有患者均接受双侧对比静脉造影，并由两名主治放射科医生对图像进行分析。静脉阻塞分为中度狭窄（直径减少50-75%）、重度狭窄（>75%）或完全闭塞。 25%的患者出现不同程度的静脉阻塞。 9%的患者出现完全闭塞，6%的患者出现重度狭窄，10%的患者出现中度狭窄。在初次植入 ICD 系统之前安装起搏器的患者静脉阻塞的发生率增加 (67%)。与使用额外的上腔静脉 (SVC) 电击线圈的患者相比，使用单根除颤器导线的患者没有发现差异。然而，单个 ICD 导线中 SVC 中第二个电击线圈的存在与静脉阻塞发生率的增加有关。硅胶和聚氨酯绝缘导线之间没有发现差异。结论本研究表明ICD植入后静脉阻塞发生的频率相对较高。因此，如果怀疑先前存在的导线出现故障或考虑进行系统升级，则应始终进行对比静脉造影。 (C) 2003 年欧洲心脏病学会。由爱思唯尔有限公司出版。保留所有权利。
Aims The number of implantable cardioverter defibrillator (10) implantations, as well as follow-up procedures such as generator exchanges, lead revisions and lead system upgrades, is ever-increasing. Lead revisions and implantation of additional leads require venous access at the site of the previous ICD implantation. The aim of our study was therefore to evaluate the incidence of venous obstruction after chronic transvenous ICD system implantation.Methods and results One hundred and five consecutive patients admitted for their first elective ICD generator replacement were included. All patients underwent bilateral contrast venography and the images were analyzed by two attending radiologists. Venous obstruction was classified as moderate stenosis (50-75% diameter reduction), severe stenosis (>75%) or total occlusion. Venous obstruction of various degrees was found in 25% of the patients. Complete occlusion was found in 9%, severe stenosis in 6% and moderate stenosis in 10% of the patients. The incidence of venous obstruction was increased in patients with a pacemaker prior to the initial ICD system implantation (67%). No difference was found in patients with a single defibrillator lead compared with patients who had an additional superior vena cava (SVC) shocking coil. However, the presence of a second shocking coil in the SVC incorporated in a single ICD lead was associated with an increased incidence of venous obstruction. No difference was found between silicone and polyurethane insulated leads.Conclusion This study shows that venous obstruction occurs relatively frequently after ICD implantation. Therefore, contrast venography should always be obtained if malfunction of a preexistent lead is suspected or a system upgrade is considered. (C) 2003 The European Society of Cardiology. Published by Elsevier Ltd. All rights reserved.