What is the prevalence of subclavian vein occlusion and pathological changes detected by duplex sonography in patients with transvenous pacemaker leads?
Duplex sonography is recommended to exclude totally thrombosed subclavian veins prior to replacing pacemaker leads, as clinical diagnosis of occlusion is uncertain and 11% of patients have asymptomatic occlusion.
Thrombosis of the subclavian vein can occur after the implantation of transvenous pacemaker electrodes. Although this is seldom followed by thromboembolic complications, it can cause problems when replacing the leads. To assess the impact of the pacemaker leads on the subclavian vein, a study using noninvasive duplex sonography was performed on 56 patients at an average of 41 months after the implantation. Forty-three percent of the patients were found to have a normal function of the subclavian vein, 46% developed pathological changes of the vessel wall, and 11% occluded. These changes rarely caused symptoms, and, therefore, had little clinical significance. Moreover, the occlusion rate was found independent of the patient's age, the patient's sex, the number of electrodes, the procedure of implantation, and even the time from implantation. As a result, the clinical diagnosis of occlusion is uncertain. Therefore, duplex sonography is recommended as an easy means of excluding a totally thrombosed subclavian vein prior to replacing pacemaker leads.
Züber et al. (Tue,) studied this question.