Venoplasty-facilitated de novo implantation or upgrading of cardiac implantable electronic devices: a single-center experience

Background Venous occlusion is a challenging obstacle during de novo implantation or upgrading of cardiac implantable electronic devices (CIEDs), particularly in patients with chronic transvenous leads. Venoplasty offers a potential solution to restore venous access while avoiding contralateral implantation or transvenous lead extraction (TLE). Objective To evaluate the feasibility, safety, and procedural outcomes of venoplasty in patients with venous obstruction undergoing de novo CIED implantation or device upgrade. Methods This single-center retrospective study included 12 patients (median age: 69 years; 75% male) who underwent venoplasty for total or subtotal venous occlusion detected by venography between December 2022 and December 2024. Two patients had de novo CIED implantation, and 10 underwent device upgrades. Venoplasty was performed using antegrade or retrograde approaches under fluoroscopic guidance, followed by standard CIED implantation. Results Total occlusion was present in 6 patients, and subtotal occlusion in 6. The most frequent sites of obstruction were the brachiocephalic and subclavian veins. Antegrade venoplasty was successful in 11 patients, with retrograde femoral access required in 1. All patients achieved successful venous recanalization and CIED implantation without procedural complications. One patient developed subacute thrombosis due to anticoagulant non-compliance. Conclusion Venoplasty is a feasible, effective, and safe strategy for overcoming venous occlusion during de novo CIED implantation or upgrade, minimizing the need for contralateral access or TLE. It should be considered in appropriately selected patients at experienced centers.