Nonthoracotomy ICD implantation can be complicated by asymptomatic superior vena caval thrombotic occlusion, potentially due to mechanical vessel injury, even with therapeutic anticoagulation.
Alerts clinicians to possible late asymptomatic SVC occlusion after nonthoracotomy ICD despite anticoagulation; leaves open true incidence and prevention strategies.
A patient with ischemic dilated cardiomyopathy and history of ventricular fibrillation received an implantable cardioverter defibrillator by the nonthoracotomy approach. Four years later, during elective replacement of an exhausted pulse generator, a superior vena caval thrombotic occlusion with collateral circulation through the azygos and emiazygos vein systems was documented. This occlusion occurred despite an anticoagulant treatment in the standard therapeutic range. We speculate that thrombotic occlusion might be secondary to a mechanical vessel injury.
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Minen et al. (1998) studied this question.
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