Key result
Doubtful or impossible central venous access device insertion was more frequent on the side of cardiac implantable electronic devices compared to the opposite side (16.62% vs 1.15%).
Why the study?
Lead-dependent venous occlusion may impede central venous access device (CVAD) insertion, prompting assessment of the chance of CVAD implantation in patients with cardiac implantable electronic devices (CIEDs).
Cohort (n=3,075)
Answers are grounded in this paper and cite their sources.
Lead-dependent venous obstruction is common in patients with CIEDs, suggesting venography should be considered before attempting central venous access device insertion even on the contralateral side.
Background: Lead-dependent venous occlusion may impede the insertion of a central venous access device (CVAD). The aim of this retrospective, cohort study was to assess the chance of implantation of CVAD in patients with cardiac implantable electronic devices (CIEDs). Methods: We reviewed and analyzed 3,075 venograms of patients with CIEDs undergoing transvenous lead extraction (TLE) between June 2008 and July 2021. Relationship between venous patency and the chance of CVAD placement was estimated. Results: 830 (28.63%), respectively] or the superior vena cava (SVC) [21 (0.73%) cases]. Furthermore, the subclavian and brachiocephalic veins on the opposite side were also narrowed [35 (2.35%) and 27 (1.24%), respectively]. The chances of port insertion were assessed as easy on CIED side or opposite side in 2,318 (75.38%) and 2,291 (97.91%) patients, respectively), as difficult insertion/questionable performance in 246 (8.00%) and 22 (0.94% patients) and doubtful or impossible insertion/questionable performance in 511 (16.62%)/27 (1.15%) patients with CIED. Conclusions: (I) Varying degrees of lead-dependent venous obstruction (LDVO) is a frequent finding in patients with CIEDs; (II) the major thoracic veins on the opposite side of the chest may also be significantly narrowed; (III) venography should be considered before attempted CVAD insertion in patients with long lead dwell times or in patients after CIED removal, including planned contralateral port placement.
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Czajkowski et al. (2023) conducted a cohort in Patients with cardiac implantable electronic devices (CIEDs) requiring central venous access (n=3,075). Cardiac implantable electronic devices (CIEDs) vs. Opposite side (no CIED) was evaluated on Doubtful or impossible central venous access device insertion. Doubtful or impossible central venous access device insertion was more frequent on the side of cardiac implantable electronic devices compared to the opposite side (16.62% vs 1.15%).
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