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Szatmári V, Thomas R. Pulmonary Thromboembolism and Myocarditis Resulting from a Large Pacing-Lead-Associated Right Ventricular Thrombus in a Dog with Chronic Cough as Presenting Sign. Vet Sci 2024; 11:237. [PMID: 38921984 PMCID: PMC11209049 DOI: 10.3390/vetsci11060237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 05/21/2024] [Accepted: 05/22/2024] [Indexed: 06/27/2024] Open
Abstract
In the present case report, we describe the clinical course and postmortem findings of a 12-year-old Labrador retriever dog with a third-degree atrio-ventricular block that developed a chronic cough, and later dyspnea and weakness as a result of massive pulmonary thromboembolism 3 years after implantation of a transvenous permanent pacemaker. A large soft tissue mass was seen in the right ventricular chamber around the pacing lead with echocardiography. Initially, this was thought to be caused by mural bacterial endocarditis based on hyperthermia, severe leukocytosis and the appearance of runs of ventricular tachycardia, the latter suggesting myocardial damage. While blood culture results were pending, antibiotics were administered without a positive effect. Due to clinical deterioration, the owner elected for euthanasia and a post-mortem examination confirmed a right ventricular thrombus and surrounding myocarditis, without signs of bacterial infection, and a massive pulmonary thromboembolism. We conclude that pulmonary thromboembolism should be considered in dogs with a cough that have an endocardial pacing lead implanted. Serial screening for proteinuria before and after implantation of an endocardial pacing lead would allow timely initiation of prophylactic antiplatelet therapy. Local myocarditis can develop secondary to an intracavitary thrombus, which can subsequently lead to runs of ventricular tachycardia.
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Affiliation(s)
- Viktor Szatmári
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Utrecht University, 3584 CM Utrecht, The Netherlands
| | - Rachel Thomas
- Department Biomolecular Health Sciences, Faculty of Veterinary Medicine, Utrecht University, 3584 CL Utrecht, The Netherlands
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Boivin Z, Spooner Z, Jiang C, Acus K, Lu C, She T. Now You See It, Now You Don't: Point-of-Care Ultrasound Identification of Left Ventricular Thrombus-in-Transit. J Emerg Med 2024; 66:e614-e618. [PMID: 38702244 DOI: 10.1016/j.jemermed.2023.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Revised: 11/08/2023] [Accepted: 11/23/2023] [Indexed: 05/06/2024]
Abstract
BACKGROUND Left-sided intracardiac thrombi are most commonly seen in conditions with decreased cardiac flow, such as myocardial infarction or atrial fibrillation. They can be propagated into the systemic circulation, leading to a cerebrovascular accident. Identification of thrombus-in-transit via point-of-care ultrasound (POCUS) has the potential to change patient management given its association with high patient morbidity and mortality. CASE REPORT An intubated 60-year-old man was transferred to our emergency department for management of altered mental status and seizure-like activity. The patient was markedly hypotensive on arrival, and cardiac POCUS was performed to identify potential causes of hypotension. A left ventricular thrombus-in-transit was identified. The thrombus was notably absent on a repeat POCUS examination < 10 min later, which led to concern for thrombus propagation. Furthermore, the patient's vasopressor requirements had significantly increased in that time period. Subsequent emergent neuroimaging revealed a large ischemic stroke in the left internal carotid and middle cerebral artery distribution. The patient was, unfortunately, deemed to not be a candidate for either thrombectomy or thrombolysis and ultimately expired in the hospital. Why Should an Emergency Physician Be Aware of This? Serial POCUS examinations identified the propagation of this patient's thrombus-in-transit, leading the physician to change the initial presumptive diagnosis and treatment course, and pursue further imaging and workup for ischemic stroke. Identification of a thrombus-in-transit is a clue to potentially underlying critical pathology and should be followed with serial POCUS examinations to assess for treatment efficacy and thrombus propagation.
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Affiliation(s)
| | - Zhayna Spooner
- Internal Medicine Residency, University of Connecticut School of Medicine, Farmington, Connecticut
| | - Christina Jiang
- University of Connecticut School of Medicine, Farmington, Connecticut
| | - Kirstin Acus
- Department of Emergency Medicine, Hartford Hospital, Hartford Connecticut
| | - Christina Lu
- Department of Emergency Medicine, Hartford Hospital, Hartford Connecticut
| | - Trent She
- Department of Emergency Medicine, Hartford Hospital, Hartford Connecticut
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3
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McGrath C, Dixon A, Hirst C, Bode EF, DeFrancesco T, Fries R, Gordon S, Hogan D, Martinez Pereira Y, Mederska E, Ostenkamp S, Sykes KT, Vitt J, Wesselowski S, Payne JR. Pacemaker-lead-associated thrombosis in dogs: a multicenter retrospective study. J Vet Cardiol 2023; 49:9-28. [PMID: 37541127 DOI: 10.1016/j.jvc.2023.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 06/18/2023] [Accepted: 06/25/2023] [Indexed: 08/06/2023]
Abstract
INTRODUCTION Pacemaker implantation is the treatment of choice for clinically relevant bradyarrhythmias. Pacemaker-lead-associated thrombosis (PLAT) occurs in 23.0-45.0% of people with permanent transvenous pacemakers. Serious thromboembolic complications are reported in 0.6-3.5%. The incidence of PLAT in dogs is unknown. ANIMALS, MATERIALS AND METHODS multicenter retrospective study of seven centers with 606 client-owned dogs undergoing permanent pacemaker implantation between 2012 and 2019. 260 dogs with a transvenous pacemaker with echocardiographic follow-up, 268 dogs with a transvenous pacemaker without echocardiographic follow-up and 78 dogs with an epicardial pacemaker. RESULTS 10.4% (27/260) of dogs with transvenous pacemakers and echocardiographic follow-up had PLAT identified. The median time to diagnosis was 175 days (6-1853 days). Pacemaker-lead-associated thrombosis was an incidental finding in 15/27 (55.6%) dogs. Of dogs with a urine protein:creatinine ratio measured at pacemaker implantation, dogs with PLAT were more likely to have proteinuria at pacemaker implantation vs. dogs without PLAT (6/6 (100.0%) vs. 21/52 (40.4%), P=0.007). Urine protein:creatinine ratio was measured in 12/27 (44.4%) dogs at PLAT diagnosis, with proteinuria identified in 10/12 (83.3%) dogs. Anti-thrombotic drugs were used following the identification of PLAT in 22/27 (81.5%) dogs. The thrombus resolved in 9/15 (60.0%) dogs in which follow-up echocardiography was performed. Dogs with PLAT had shorter survival times from implantation compared to those without PLAT (677 days [9-1988 days] vs. 1105 days [1-2661 days], P=0.003). CONCLUSIONS Pacemaker-lead-associated thrombosis is identified in 10.4% (27/260) of dogs following transvenous pacing, is associated with proteinuria, can cause significant morbidity, and is associated with reduced survival times.
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Affiliation(s)
- C McGrath
- Langford Vets Small Animal Referral Hospital, University of Bristol, Langford House, Langford, Bristol, BS40 5DU, United Kingdom
| | - A Dixon
- Langford Vets Small Animal Referral Hospital, University of Bristol, Langford House, Langford, Bristol, BS40 5DU, United Kingdom
| | - C Hirst
- Langford Vets Small Animal Referral Hospital, University of Bristol, Langford House, Langford, Bristol, BS40 5DU, United Kingdom
| | - E F Bode
- Small Animal Teaching Hospital, Institute of Veterinary Science, University of Liverpool, Leahurst Campus, Chester High Road, Neston, Wirral, CH64 7TE, United Kingdom
| | - T DeFrancesco
- College of Veterinary Medicine, North Carolina State Veterinary Hospital, 1052 William Moore Dr., Raleigh, NC, 27607, USA
| | - R Fries
- University of Illinois Veterinary Teaching Hospital, 1008 W Hazelwood Dr., Urbana, IL, 61802, USA
| | - S Gordon
- Texas A&M University Veterinary Medical Teaching Hospital, 408 Raymond Stotzer Pkwy, College Station, TX, 77845, USA
| | - D Hogan
- Purdue University Small Animal Hospital, West Lafayette, Indiana LYNN, 625 Harrison St., West Lafayette, IN, 47907, USA
| | - Y Martinez Pereira
- Hospital for Small Animals, The Royal (Dick) School of Veterinary Studies, University of Edinburgh, Easter Bush Campus, Midlothian, EH25 9RG, United Kingdom
| | - E Mederska
- Small Animal Teaching Hospital, Institute of Veterinary Science, University of Liverpool, Leahurst Campus, Chester High Road, Neston, Wirral, CH64 7TE, United Kingdom
| | - S Ostenkamp
- Purdue University Small Animal Hospital, West Lafayette, Indiana LYNN, 625 Harrison St., West Lafayette, IN, 47907, USA
| | - K T Sykes
- Texas A&M University Veterinary Medical Teaching Hospital, 408 Raymond Stotzer Pkwy, College Station, TX, 77845, USA
| | - J Vitt
- University of Illinois Veterinary Teaching Hospital, 1008 W Hazelwood Dr., Urbana, IL, 61802, USA
| | - S Wesselowski
- Texas A&M University Veterinary Medical Teaching Hospital, 408 Raymond Stotzer Pkwy, College Station, TX, 77845, USA
| | - J R Payne
- Langford Vets Small Animal Referral Hospital, University of Bristol, Langford House, Langford, Bristol, BS40 5DU, United Kingdom.
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Domain G, Strubé C, Plourde B, Steinberg C, Sarrazin JF, Roy K, Poirier P, Philippon F. Acute transvenous pacemaker lead thrombosis early after implantation: A rare clinical scenario. Pacing Clin Electrophysiol 2023; 46:934-938. [PMID: 36550633 DOI: 10.1111/pace.14647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 11/22/2022] [Accepted: 12/12/2022] [Indexed: 12/24/2022]
Abstract
Symptomatic thrombus formation due to a permanent pacemaker (PM) lead is a rare complication. It could be associated with serious outcome and should be suspected in patients who present with unexplained right heart failure, dyspnea, or syncope following dual-chamber PM implantation. A timely decision to perform an echocardiographic examination, followed by medical, thrombolytic, or surgical treatment can be necessary. We describe the case of an 84-year-old man who presented with syncope and hypotension a few days after PM implantation. A transesophageal echocardiography revealed a mobile mass in the right atrium attached to the pacemaker lead. Intravenous heparin allowed a complete resolution of the thrombus.
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Affiliation(s)
- Guillaume Domain
- Institut universitaire de cardiologie et de pneumologie de Québec-Université Laval, Electrophysiology Division, Québec, Canada
| | - Camille Strubé
- Institut universitaire de cardiologie et de pneumologie de Québec-Université Laval, Electrophysiology Division, Québec, Canada
| | - Benoit Plourde
- Institut universitaire de cardiologie et de pneumologie de Québec-Université Laval, Electrophysiology Division, Québec, Canada
| | - Christian Steinberg
- Institut universitaire de cardiologie et de pneumologie de Québec-Université Laval, Electrophysiology Division, Québec, Canada
| | - Jean-François Sarrazin
- Institut universitaire de cardiologie et de pneumologie de Québec-Université Laval, Electrophysiology Division, Québec, Canada
| | - Karine Roy
- Institut universitaire de cardiologie et de pneumologie de Québec-Université Laval, Electrophysiology Division, Québec, Canada
| | - Paul Poirier
- Institut universitaire de cardiologie et de pneumologie de Québec-Université Laval, Electrophysiology Division, Québec, Canada
| | - François Philippon
- Institut universitaire de cardiologie et de pneumologie de Québec-Université Laval, Electrophysiology Division, Québec, Canada
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Witte MC, Garry R. Superior Vena Cava Syndrome from Pacemaker Leads in an Elderly Woman. Cureus 2023; 15:e40323. [PMID: 37448408 PMCID: PMC10338046 DOI: 10.7759/cureus.40323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/10/2023] [Indexed: 07/15/2023] Open
Abstract
Superior vena cava (SVC) syndrome is a constellation of clinical signs and symptoms secondary to obstruction of the SVC. The most common etiology is malignancy. However, the incidence of device-related SVC syndrome is increasing. The current management for device-related SVC syndrome includes open surgical intervention, endovascular repair, or systemic anticoagulation. We present a case of a 95-year-old female who developed SVC syndrome due to thrombosis secondary to pacemaker leads. She was treated conservatively due to her frailty and comorbid conditions. We discuss the evolving etiology of SVC syndrome, the most common presenting signs and symptoms, and a variety of potential treatments for non-malignant SVC syndrome. We also provide an example of when conservative management for chronic device-related SVC syndrome is appropriate.
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Affiliation(s)
- Michael C Witte
- Graduate Medical Education, North Collier Hospital (NCH) Healthcare System, Naples, USA
| | - Ron Garry
- Geriatrics, North Collier Hospital (NCH) Healthcare System, Naples, USA
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Zamora R, Boivin Z, Kohen B. Man With Incidental Ventricular Mass. Ann Emerg Med 2023; 81:e109-e110. [PMID: 37085211 DOI: 10.1016/j.annemergmed.2022.10.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 10/26/2022] [Accepted: 10/31/2022] [Indexed: 04/23/2023]
Affiliation(s)
- Rolando Zamora
- Department of Emergency Medicine, Memorial Healthcare System, Hollywood, FL
| | - Zachary Boivin
- Department of Emergency Medicine, UConn Health, Farmington, CT
| | - Brian Kohen
- Department of Emergency Medicine, Memorial Healthcare System, Hollywood, FL
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7
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PaceMaker lead and atrial thrombosis, a rare event but of high clinical importance. COR ET VASA 2022. [DOI: 10.33678/cor.2021.100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Lee WC, Huang MP. Lead thrombus under standard-dose edoxaban in a patient with normal to high creatinine clearance and protein S deficiency. Thromb J 2021; 19:50. [PMID: 34273971 PMCID: PMC8285875 DOI: 10.1186/s12959-021-00302-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 07/07/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Non-vitamin K antagonist oral anticoagulants (NOACs) are as effective and safe as warfarin for thromboembolic prevention and treatment. The efficacy of NOACs lacks evidence from large and randomized studies in patients with inherited severe thrombophilia, including protein S deficiency. Further, some concerns still exist regarding the relative efficacy of edoxaban in preventing arterial thromboembolism in patients with normal to high creatinine clearance (CrCl). We present a case of a rare complication of lead thrombus under standard-dose edoxaban in a patient with protein S deficiency and supernormal renal function. CASE PRESENTATION A 65-year-old man experienced persistent chest tightness and a high level of D-dimer. Chest computed tomography (CT) showed a lead thrombus at the superior vena cava. He had a medical history including, paroxysmal atrial fibrillation (PAf), sick sinus syndrome after permanent pacemaker implantation, and transient ischemic attack. He received standard-dose edoxaban (60 mg daily) after PAf was diagnosed. His estimated CrCl was 98.6-102.1 mL/min. However, protein S deficiency (22.8%; normal range: 55-130%) was diagnosed. After switching to dabigatran (150 mg twice daily) for 3 months, the chest CT showed lead thrombus resolution and no symptoms were seen during the follow-up period. CONCLUSIONS This case was a rare complication of lead thrombus in a protein S deficient patient with normal renal function receiving standard-dose edoxaban. Edoxaban efficacy is uncertain in patients with protein S deficiency, and intracardiac devices also increase the risk of thromboembolic events.
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Affiliation(s)
- Wei-Chieh Lee
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan. .,Department of Internal Medicine, Division of Cardiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, 123, Ta Pei Road, Niao Sung District, Kaohsiung City, 83301, Taiwan.
| | - Min-Ping Huang
- Department of Internal Medicine, Division of Cardiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, 123, Ta Pei Road, Niao Sung District, Kaohsiung City, 83301, Taiwan
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Sherk WM, Khaja MS, Good ED, Cunnane RT, Dasika NL, Williams DM. Hybrid venous recanalization and cardiac implantable electronic device lead revision procedures: A single-center retrospective analysis of 38 patients. Clin Imaging 2019; 58:145-151. [PMID: 31336361 DOI: 10.1016/j.clinimag.2019.07.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 07/02/2019] [Accepted: 07/09/2019] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of this study was to describe the safety and efficacy of hybrid recanalization procedures in a series of patients with obstructed central veins requiring cardiac implantable electronic device (CIED) revision. METHODS Between 2008 and 2016, 38 consecutive patients (24 M; age 60.5 ± 16.2 years; range 25-87 years) with central venous obstruction underwent 42 recanalization interventions performed in conjunction with CIED revision or extraction. Fifty percent of patients (19/38) presented with veno-occlusive symptoms, and 13% (5/38) of patients had CIED leads with an ipsilateral upper extremity dialysis conduit. RESULTS Ninety-one percent (38/42) of all procedures resulted in successful recanalization and CIED revision. Twenty-four percent (9/38) of all patients required secondary procedures due to recurrent stenosis, and 78% (7/9) of those requiring secondary procedures had indwelling dialysis conduits and/or clinical symptoms related to venous occlusion before the initial procedure. There were complications in 2 patients related to recanalization, and in 3 related to CIED revision. CONCLUSIONS Recanalization of central venous stenosis/occlusion in patients with CIED can be technically challenging but is successful in most patients. Symptomatic patients and those with dialysis conduits often require more aggressive revascularization interventions and may be at increased risk of complication or need for secondary interventions.
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Affiliation(s)
- William M Sherk
- Department of Radiology, Division of Vascular & Interventional Radiology, University of Michigan, 1500 E. Medical Center Drive, Ann Arbor, MI 48109, United States of America.
| | - Minhaj S Khaja
- Department of Radiology, Division of Vascular & Interventional Radiology, University of Michigan, 1500 E. Medical Center Drive, Ann Arbor, MI 48109, United States of America.
| | - Eric D Good
- Division of Cardiology, Section of Electrophysiology, University of Michigan, 1500 E. Medical Center Dr, Ann Arbor, MI 48109, United States of America
| | - Ryan T Cunnane
- Division of Cardiology, Section of Electrophysiology, University of Michigan, 1500 E. Medical Center Dr, Ann Arbor, MI 48109, United States of America.
| | - Narasimham L Dasika
- Department of Radiology, Division of Vascular & Interventional Radiology, University of Michigan, 1500 E. Medical Center Drive, Ann Arbor, MI 48109, United States of America.
| | - David M Williams
- Department of Radiology, Division of Vascular & Interventional Radiology, University of Michigan, 1500 E. Medical Center Drive, Ann Arbor, MI 48109, United States of America.
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Di Vincenzo A, Rizzo A, Russo L, Mioni R. Pacemaker-associated thrombosis in ongoing therapy with edoxaban tosylate. J Thromb Thrombolysis 2018; 46:549-550. [PMID: 30182222 DOI: 10.1007/s11239-018-1733-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Thromboembolism is a known complication of pacemaker implantation. However, published literature describes only a few cases, in which the events occurred in absence of antithrombotic prophylaxis, not routinely employed for its prevention in current clinical practice. We report a case of pacemaker lead-associated thrombosis in a patient taking continuative oral anticoagulant therapy with edoxaban tosylate (edoxaban). No data in present literature supports the use of anticoagulant prophylaxis for pacemaker lead thrombosis. In our report ongoing treatment with edoxaban proved ineffective for thrombosis prevention. We also discuss the role of three-dimensional transthoracic echocardiography for diagnostic assessment of thrombosis in a fragile patient.
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Affiliation(s)
- Angelo Di Vincenzo
- Internal Medicine 3, University Hospital of Padova, Via Giustiniani 2, 35128, Padua, Italy.
| | | | - Lucia Russo
- Internal Medicine 3, University Hospital of Padova, Via Giustiniani 2, 35128, Padua, Italy
| | - Roberto Mioni
- Internal Medicine 3, University Hospital of Padova, Via Giustiniani 2, 35128, Padua, Italy
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11
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Method for preclinical pathology evaluation and analysis of cardiovascular implantable electronic device implant sites. Cardiovasc Pathol 2018; 36:44-52. [DOI: 10.1016/j.carpath.2018.05.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Revised: 03/23/2018] [Accepted: 05/11/2018] [Indexed: 11/22/2022] Open
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12
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Sotiriadis C, Volpi S, Douek P, Chouiter A, Muller O, Qanadli SD. Are Endovascular Interventions for Central Vein Obstructions due to Cardiac Implanted Electronic Devices Effective? Front Surg 2018; 5:49. [PMID: 30105227 PMCID: PMC6077194 DOI: 10.3389/fsurg.2018.00049] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 07/10/2018] [Indexed: 11/17/2022] Open
Abstract
Objective: One of the late-onset complications of cardiac implanted electronic devices (CIEDs) is central venous obstruction (CVO). The aim of this study was to investigate the feasibility, efficacy, and safety of endovascular treatment of CIED-related CVOs. Methods:Eighteen patients who underwent endovascular management of their device-related CVO were reviewed. Patients were classified into three groups: Group I patients were asymptomatic and needed lead replacement; Group II patients presented with symptomatic CVO without lead dysfunction, and Group III patients were referred with both symptomatic CVO and lead dysfunction. A treatment strategy involved recanalization and balloon angioplasty for Group I and angioplasty/stents for Groups II and III. Technical success, clinical success, complications, and long-term follow-up were assessed. Results: Thirteen patients were in Group I, four in Group II, and one in Group III. Technical and clinical success was achieved in 17 patients (94%). No major complications were reported. Restenosis was observed in two patients at 40 and 42 weeks of follow-up, and these patients were successfully treated with angioplasty. Conclusion: Endovascular management of CVO due to CIED is a safe and efficient technique. Plain balloon angioplasty is sufficient for lead replacement purposes, while stenting is needed for symptomatic CVO to achieve good long-term patency.
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Affiliation(s)
- Charalampos Sotiriadis
- Cardiothoracic and Vascular Unit, Department of Radiology, University Hospital of Lausanne, Université de Lausanne, Lausanne, Switzerland
| | - Stephanie Volpi
- Cardiothoracic and Vascular Unit, Department of Radiology, University Hospital of Lausanne, Université de Lausanne, Lausanne, Switzerland
| | - Pauline Douek
- Cardiothoracic and Vascular Unit, Department of Radiology, University Hospital of Lausanne, Université de Lausanne, Lausanne, Switzerland
| | - Amine Chouiter
- Cardiothoracic and Vascular Unit, Department of Radiology, University Hospital of Lausanne, Université de Lausanne, Lausanne, Switzerland
| | - Olivier Muller
- Cardiothoracic and Vascular Unit, Department of Radiology, University Hospital of Lausanne, Université de Lausanne, Lausanne, Switzerland
| | - Salah D Qanadli
- Cardiothoracic and Vascular Unit, Department of Radiology, University Hospital of Lausanne, Université de Lausanne, Lausanne, Switzerland
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Rajah G, Saber H, Singh R, Rangel-Castilla L. Endovascular delivery of leads and stentrodes and their applications to deep brain stimulation and neuromodulation: a review. Neurosurg Focus 2018; 45:E19. [DOI: 10.3171/2018.4.focus18130] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Neuromodulation and deep brain stimulation (DBS) have been increasingly used in many neurological ailments, including essential tremor, Parkinson’s disease, epilepsy, and more. Yet for many patients and practitioners the desire to utilize these therapies is met with caution, given the need for craniotomy, lead insertion through brain parenchyma, and, at many times, bilateral invasive procedures. Currently endovascular therapy is a standard of care for emergency thrombectomy, aneurysm treatment, and other vascular malformation/occlusive disease of the cerebrum. Endovascular techniques and delivery catheters have advanced greatly in both their ability to safely reach remote brain locations and deliver devices. In this review the authors discuss minimally invasive endovascular delivery of devices and neural stimulating and recording from cortical and DBS targets via the neurovascular network.
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Affiliation(s)
- Gary Rajah
- Departments of 1Neurosurgery and
- 3Wayne State University School of Medicine, Detroit, Michigan; and
| | - Hamidreza Saber
- 2Neurology, Wayne State University, and
- 3Wayne State University School of Medicine, Detroit, Michigan; and
| | - Rasanjeet Singh
- 3Wayne State University School of Medicine, Detroit, Michigan; and
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Ito T, Goto T, Kawada Y, Ohte N. Delayed right ventricular perforation complicated by intracardiac thrombosis after implantable cardioverter-defibrillator implantation. J Arrhythm 2018; 34:74-76. [PMID: 29721117 PMCID: PMC5828261 DOI: 10.1002/joa3.12007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Accepted: 10/02/2017] [Indexed: 11/12/2022] Open
Abstract
Cardiac perforation and intracardiac thrombosis are infrequent complications after implantable cardioverter‐defibrillator (ICD) implantation, and a case of lead perforation complicated by thrombosis is extremely rare. We report the case of a 66‐year‐old man with delayed ICD lead perforation concomitant with intracardiac lead thrombosis successfully treated by anticoagulant therapy followed by transvenous lead management.
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Affiliation(s)
- Tsuyoshi Ito
- Department of Cardio-Renal Medicine and Hypertension Nagoya City University Graduate School of Medical Sciences Nagoya Japan
| | - Toshihiko Goto
- Department of Cardio-Renal Medicine and Hypertension Nagoya City University Graduate School of Medical Sciences Nagoya Japan
| | - Yu Kawada
- Department of Cardio-Renal Medicine and Hypertension Nagoya City University Graduate School of Medical Sciences Nagoya Japan
| | - Nobuyuki Ohte
- Department of Cardio-Renal Medicine and Hypertension Nagoya City University Graduate School of Medical Sciences Nagoya Japan
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15
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Zucchelli G, Favilli E, Viani S, Barletta V, Di Cori A, Segreti L, Bongiorni MG. Leadless pacing in a patient with superior vena cava syndrome undergoing lead extraction and percutaneous angioplasty. J Cardiol Cases 2018; 17:212-214. [PMID: 30279895 DOI: 10.1016/j.jccase.2018.02.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 02/11/2018] [Accepted: 02/17/2018] [Indexed: 11/30/2022] Open
Abstract
Superior vena cava (SVC) syndrome is an uncommon but serious complication associated with chronic transvenous implanted leads. In the recent past, open-heart surgery combining lead extraction and epicardial implant was usually performed to reduce syndrome recurrences. We describe the case of a 78-year-old man successfully treated by percutaneous lead extraction associated with venous balloon angioplasty and reimplantation of leadless pacemaker. <Learning objective: Chronic vascular complications following lead implantation usually require surgical treatment, due to the need for subsequent epicardial implantation. Percutaneous lead extraction along with leadless pacing allowed effective non-surgical management of chronic complications of transvenous pacing.>.
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Affiliation(s)
- Giulio Zucchelli
- Cardiac Thoracic and Vascular Department - AOUP, Santa Chiara University Hospital, Pisa, Italy
| | - Elena Favilli
- Cardiac Thoracic and Vascular Department - AOUP, Santa Chiara University Hospital, Pisa, Italy
| | - Stefano Viani
- Cardiac Thoracic and Vascular Department - AOUP, Santa Chiara University Hospital, Pisa, Italy
| | - Valentina Barletta
- Cardiac Thoracic and Vascular Department - AOUP, Santa Chiara University Hospital, Pisa, Italy
| | - Andrea Di Cori
- Cardiac Thoracic and Vascular Department - AOUP, Santa Chiara University Hospital, Pisa, Italy
| | - Luca Segreti
- Cardiac Thoracic and Vascular Department - AOUP, Santa Chiara University Hospital, Pisa, Italy
| | - Maria Grazia Bongiorni
- Cardiac Thoracic and Vascular Department - AOUP, Santa Chiara University Hospital, Pisa, Italy
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16
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Lam C. Permanent Cardiac Pacemaker: an Emergency Perspective. HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490790100800310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The number of patients with permanent pacemaker are increasing and may present into the emergency department with a variety of complications and malfunctions. The presence of a pacemaker may also affect management of unrelated medical issues. This article review the complications of the implant procedure, the causes, diagnosis and management of pacemaker malfunction, the pacemaker syndrome, Twiddler's syndrome. Interaction of permanent pacemaker with other medical condition and its implication in Emergency Department environment are also discussed.
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Affiliation(s)
- Cw Lam
- Prince of Wales Hospital, Accident and Emergency Department, Shatin, N.T., Hong Kong
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17
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Maseda Uriza R, Jurado-Román A, Jimenez Díaz J, Piqueras Flores J, Higuera Sobrino F, Oliva De Anquín E. Hybrid Approach for the Treatment of Superior Vena Cava Syndrome Induced by Pacemaker. Ann Thorac Surg 2017; 104:e131-e132. [DOI: 10.1016/j.athoracsur.2017.02.063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2017] [Revised: 02/16/2017] [Accepted: 02/18/2017] [Indexed: 11/25/2022]
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18
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Deser SB, Demirag MK. A Therapeutic Challenge: Management of Atrial Thrombus. JOURNAL OF CLINICAL AND EXPERIMENTAL INVESTIGATIONS 2016. [DOI: 10.5799/jcei.328366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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19
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Venous Obstruction Following Pacemaker or Implantable Cardioverter-Defibrillator Implantation, Mini Review. INTERNATIONAL JOURNAL OF CARDIOVASCULAR PRACTICE 2016. [DOI: 10.20286/ijcp-010201] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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20
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Rapid Detection of Intracardiac Thrombus with Bedside Echocardiography. J Emerg Med 2016; 50:501-3. [DOI: 10.1016/j.jemermed.2015.11.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Accepted: 11/13/2015] [Indexed: 11/22/2022]
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21
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Abstract
Devices such as pacemakers and implantable cardioverter-defibrillators (ICDs) are commonly inserted to treat unstable cardiac rhythm disturbances. Despite the benefits of these devices on mortality and morbidity rates, patients often present to the emergency department with complaints related to device insertion or malfunction. Emergency physicians must be able to rapidly identify potential life threats caused by pacemaker malfunction, ICD firing, and complications associated with implantation of the devices.
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22
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Chung MY, Chae SM, Kim CJ. Fatal cardiac thromboembolism in a patient with a pacemaker during ureteroscopic lithotripsy for ureter stone: a case report. Korean J Anesthesiol 2015; 68:74-7. [PMID: 25664159 PMCID: PMC4318869 DOI: 10.4097/kjae.2015.68.1.74] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Revised: 09/03/2014] [Accepted: 09/03/2014] [Indexed: 11/26/2022] Open
Abstract
Intracardiac thrombosis is an infrequent and fatal complication in patients with an inserted pacemaker. A patient with an inserted pacemaker scheduled for ureter stone removal experienced cardiac arrest and cardiopulmonary resuscitation under general anesthesia. Echocardiography showed multiple intracardiac thrombi. Preoperative diagnostic workup including echocardiography for the detection of pacemaker lead thrombus, and the need for anticoagulation should be considered in patients with an inserted pacemaker and high-risk factors for thrombosis.
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Affiliation(s)
- Mee Young Chung
- Department of Anesthesiology and Pain Medicine, St. Paul's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Su Min Chae
- Department of Anesthesiology and Pain Medicine, St. Paul's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Chang Jae Kim
- Department of Anesthesiology and Pain Medicine, St. Paul's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea
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23
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Sideris S, Benetos G, Lazaros G, Gatzoulis K, Lymperiadis D, Stavropoulos G, Toutouzas K, Manakos K, Traxanas K, Trantalis G, Tousoulis D, Kallikazaros I. An unexpected complication during percutaneous pacemaker lead extraction unveiled by transesophageal echocardiography. Int J Cardiol 2014; 177:e125-7. [DOI: 10.1016/j.ijcard.2014.09.077] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2014] [Accepted: 09/20/2014] [Indexed: 11/16/2022]
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24
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Risk of Cerebrovascular Events in Patients With Patent Foramen Ovale and Intracardiac Devices. JACC Cardiovasc Interv 2014; 7:1221-6. [DOI: 10.1016/j.jcin.2014.04.025] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Revised: 03/31/2014] [Accepted: 04/25/2014] [Indexed: 11/19/2022]
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25
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Kokotsakis J, Chaudhry UAR, Tassopoulos D, Harling L, Ashrafian H, Vernandos M, Kanakis M, Athanasiou T. Surgical management of superior vena cava syndrome following pacemaker lead infection: a case report and review of the literature. J Cardiothorac Surg 2014; 9:107. [PMID: 24947452 PMCID: PMC4075978 DOI: 10.1186/1749-8090-9-107] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2014] [Accepted: 06/13/2014] [Indexed: 11/10/2022] Open
Abstract
Superior vena cava (SVC) syndrome is a known but rare complication of pacemaker lead implantation, accounting for approximately less than 0.5% of cases. Its pathophysiology is due to either infection or endothelial mechanical stress, causing inflammation and fibrosis leading to thrombosis, and therefore stenosis of the SVC. Due to the various risks including thrombo-embolic complications and the need to provide symptomatic relief, medical and surgical interventions are sought early. We present the case of a 48-year Caucasian male who presented with localised swelling and pain at the site of pacemaker implantation. Inflammatory markers were normal, but diagnostic imaging revealed three masses along the pacemaker lead passage. A surgical approach using cardiopulmonary bypass and circulatory arrest was used to remove the vegetations. Culture from the vegetations showed Staphylococcus epidermidis. The technique presented here allowed for safe and effective removal of both the thrombus and infected pacing leads, with excellent exposure and minimal post-procedure complications.
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Affiliation(s)
| | | | | | | | | | | | | | - Thanos Athanasiou
- Department of Surgery and Cancer, Imperial College London, 10th Floor, QEQM Building, St Mary's Hospital Campus, South Wharf Road, London W2 1NY, UK.
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26
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Mountfort K, Knops R, Sperzel J, Neuzil P. The Promise of Leadless Pacing: Based on Presentations at Nanostim Sponsored Symposium Held at the European Society of Cardiology Congress 2013, Amsterdam, The Netherlands, 2 September 2013. Arrhythm Electrophysiol Rev 2014; 3:51-5. [PMID: 26835067 DOI: 10.15420/aer.2011.3.1.51] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Accepted: 04/24/2014] [Indexed: 11/04/2022] Open
Abstract
Pacemaker technologies have advanced dramatically over the decades since they were first introduced, and every year many thousands of new implants are performed worldwide. However, there continues to be a high incidence of acute and chronic complications, most of which are linked to the lead or the surgical pocket created to hold the device. A leadless pacemaker offers the possibility of bypassing these complications, but requires a catheter-based delivery system and a means of retrieval at the end of the device's life, as well as a way of repositioning to achieve satisfactory pacing thresholds and R waves, a communication system and low peak energy requirements. A completely self-contained leadless pacemaker has recently been developed, and its key characteristics are discussed, along with the results of an efficacy and safety trial in an animal model. The results of the LEADLESS study, the first human trial to look at safety and feasibility of the leadless device, are discussed and the possible implications for future clinical practice examined.
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Affiliation(s)
| | - Reinoud Knops
- Electrophysiologist, Academic Medical Centre, University of Amsterdam, The Netherlands
| | - Johannes Sperzel
- Director, Department of Cardiology, Kerckhoff Heart Centre, Bad Nauheim, Germany
| | - Petr Neuzil
- Chairman, Department of Cardiology, Homolka Hospital, Prague, Czech Republic
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27
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Almomani A, Siddiqui K, Ahmad M. Echocardiography in patients with complications related to pacemakers and cardiac defibrillators. Echocardiography 2014; 31:388-99. [PMID: 24341293 DOI: 10.1111/echo.12483] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
The evolving indications and uses for implantable cardiac devices have led to a significant increase in the number of implanted devices each year. Implantation of endocardial leads for permanent pacemakers and cardiac defibrillators can cause many delayed complications. Complications may be mechanical and related to the interaction of the device leads with the valves and endomyocardium, e.g., perforation, infection, and thrombosis, or due to the electrical pacing of the myocardium and conduction abnormalities, e.g., left ventricular dyssynchrony. Tricuspid regurgitation, another delayed complication in these patients, may be secondary to both mechanical and pacing effects of the device leads. Echocardiography plays an important role in the diagnosis of these device-related complications. Both two-dimensional transthoracic echocardiography and transesophageal echocardiography provide useful diagnostic information. Real time three-dimensional echocardiography is a novel technique that can further enhance the detection of lead-related complications.
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Affiliation(s)
- Ahmed Almomani
- Division of Cardiology, Department of Medicine, University of Texas Medical Branch, Galveston, Texas
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28
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One step behind to step ahead - femoral approach to stabilize and to extract functional pacing lead to regain venous access. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2014; 9:310-2. [PMID: 24570742 PMCID: PMC3915996 DOI: 10.5114/pwki.2013.37519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2013] [Revised: 05/25/2013] [Accepted: 06/28/2013] [Indexed: 11/22/2022] Open
Abstract
Transvenous lead extraction can be a method to regain venous access. We present the case of a man, aged 67, with indications to upgrade an ICD to a resynchronization therapy device. Since innominate vein occlusion was diagnosed and extraction of an abandoned ventricular pacing lead did not provide lumen regain, a functional atrial lead was extracted with the femoral approach to stabilization and venous access was regained. Asymptomatic vein wall damage but no other complications were recorded. The simultaneous application of different techniques to regain venous access may allow success of the final procedure in system upgrading.
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29
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Espitia O, Guerin P, Néel A, Espitia-Thibault A, Pottier P, Planchon B, Pistorius MA. [Superior vena cava syndrome induced by pacemaker probes, 12 years after introduction]. JOURNAL DES MALADIES VASCULAIRES 2013; 38:193-197. [PMID: 23433510 DOI: 10.1016/j.jmv.2013.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2012] [Accepted: 12/31/2012] [Indexed: 06/01/2023]
Abstract
Superior vena cava syndrome is a rare disease, most often found to result from a malignant process, which causes extrinsic compression of the superior vena cava. In recent years, there has been an increase of superior vena cava syndrome related to medical devices (implantable site, pacemaker [PM], central venous line for parenteral nutrition...). We report the case of a 37-year-old patient who developed a superior vena cava syndrome 12 years after implantation of a PM. The diagnosis was established on venography after two negative venous-CT focused on the superior vena cava. The superior vena cava syndrome improved immediately after angioplasty and stenting covering the PM probes at the superior vena cava/brachiocephalic venous trunk junction.
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Affiliation(s)
- O Espitia
- Service de Médecine Interne, Hôtel-Dieu, CHU de Nantes, place Alexis-Ricordeau, 44093 Nantes cedex 1, France.
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30
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Lelakowski J, Domagała TB, Rydlewska A, Januszek R, Kotula-Horowitz K, Majewski J, Ząbek A, Małecka B. Relationship between changes in selected thrombotic and inflammatory factors, echocardiographic parameters and the incidence of venous thrombosis after pacemaker implantation based on our own observations. Arch Med Sci 2012; 8:1027-34. [PMID: 23319977 PMCID: PMC3542480 DOI: 10.5114/aoms.2012.28600] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2011] [Revised: 05/13/2011] [Accepted: 08/31/2011] [Indexed: 12/01/2022] Open
Abstract
INTRODUCTION Thrombosis (VTh) is a rare dangerous complication of pacemaker implantation (PM). The aim of the study was to determine the dynamics of change in selected thrombotic and inflammatory factors after PM. MATERIAL AND METHODS The study involved 81 patients (30 female, mean age: 71.1 years) with PM, divided into two groups. Group A (71 patients) consisted of patients without VTh, whereas group B (10 patients) comprised the patients with VTh. A transthoracic echocardiogram (TTE) and a venous ultrasound (VU) examination were performed. The levels of D-dimers, fibrinogen, tissue factor (TF), factor VII, plasminogen activator inhibitor-1 (PAI-1), interleukin-6 (IL-6) and high-sensitivity C-reactive protein (hsCRP) were determined in the venous blood. After PM, the TTE and VU examinations were repeated at 6 and 12 months, and blood analyses were performed within 7 days after PM, and subsequently at 6 and 12 months. RESULTS In 10 patients of group B, symptomatic VTh occurred at a mean time of 13.06 months after PM. Initially, the levels of IL-6, hsCRP, D-dimers, fibrinogen, TF, VII factor and PAI-1 were considerably higher in group B than in group A. In all patients the levels of these factors kept on increasing for up to 7 days after the procedure. In group A they subsequently decreased, whereas in group B they continued to rise. CONCLUSIONS Increased levels of inflammatory and thrombotic factors were observed in patients with VTh before and after PM. The factors of highest risk of VTh occurrence were D-dimers, fibrinogen and TF.
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Affiliation(s)
- Jacek Lelakowski
- Department of Electrocardiology, Institute of Cardiology, The John Paul II Hospital, School of Medicine, Jagiellonian University, Cracow, Poland
| | - Teresa Barbara Domagała
- Department of Internal Medicine, School of Medicine, Jagiellonian University, Cracow, Poland
- Department of Medical Biochemistry, School of Medicine, Jagiellonian University, Cracow, Poland
| | - Anna Rydlewska
- Department of Electrocardiology, Institute of Cardiology, The John Paul II Hospital, School of Medicine, Jagiellonian University, Cracow, Poland
| | - Rafał Januszek
- Department of Internal Medicine, School of Medicine, Jagiellonian University, Cracow, Poland
| | | | - Jacek Majewski
- Department of Electrocardiology, Institute of Cardiology, The John Paul II Hospital, School of Medicine, Jagiellonian University, Cracow, Poland
| | - Andrzej Ząbek
- Department of Electrocardiology, Institute of Cardiology, The John Paul II Hospital, School of Medicine, Jagiellonian University, Cracow, Poland
| | - Barbara Małecka
- Department of Electrocardiology, Institute of Cardiology, The John Paul II Hospital, School of Medicine, Jagiellonian University, Cracow, Poland
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31
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de Laforcade A. Diseases associated with thrombosis. Top Companion Anim Med 2012; 27:59-64. [PMID: 23031457 DOI: 10.1053/j.tcam.2012.07.002] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2012] [Accepted: 07/13/2012] [Indexed: 01/10/2023]
Abstract
Coagulation abnormalities are commonly encountered in critical illness. Traditionally, clinically relevant coagulation disorders have consisted mostly of bleeding associated with advanced stages of disseminated intravascular coagulation or toxin ingestion. However, advances in critical care have highlighted hypercoagulability as a clinically relevant state that must be recognized and treated to optimize the chances of a positive outcome. Retrospective studies of dogs with confirmed thrombosis in varying locations have identified populations most likely to experience hypercoagulable states. Diseases most frequently complicated by thrombosis include immune-mediated disease, neoplasia, systemic inflammation and sepsis, cardiac disease, protein-losing states, and infectious diseases. In this report, the existing retrospective studies will be discussed along with a review of specific disease processes that predispose to a hypercoagulable state. Studies targeting those populations most at risk for thrombotic complications are necessary for better understanding the need for prophylactic anticoagulant therapy.
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32
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Takeuchi D, Tomizawa Y. Pacing device therapy in infants and children: a review. J Artif Organs 2012; 16:23-33. [PMID: 23104398 DOI: 10.1007/s10047-012-0668-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2012] [Accepted: 10/10/2012] [Indexed: 01/20/2023]
Abstract
The number of pediatric pacemakers implanted is still relatively small. Children requiring pacing therapy have characteristics that are distinct from those of adults, including physical size, somatic growth, and cardiac anomalies. Considering these features, long-term follow-up of pediatric pacemaker implantation is necessary. Selection of appropriate generators, pacing modes, pacing sites, and leads is important. Generally, epicardial leads are commonly used in small infants. On the other hand, the use of endocardial leads in children is increasing worldwide because of their benefits over epicardial leads, such as minimal invasiveness, lower pacing threshold, and longer generator longevity. Endocardial leads are not suitable for patients with intracardiac shunts because of the high risk of systemic thrombosis. Venous occlusion is another significant problem with endocardial leads. With the increase in the number of pacing device implantations, the incidence of infection from such devices is also increasing. Complete device removal is sometimes recommended to treat device infection, but experience in the removal of endocardial leads in children is still scarce. This article gives an overview of pacing therapy in the pediatric population, including discussions on new pacing systems, such as remote monitoring systems, magnetic imaging compliant pacemaker systems, and leadless pacing devices.
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Affiliation(s)
- Daiji Takeuchi
- Department of Pediatric Cardiology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan.
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33
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Gebreyes AT, Pant HN, Williams DM, Kuehl SP. Be aware of wires in the veins: a case of superior vena cava syndrome in a patient with permanent pacemaker. J Community Hosp Intern Med Perspect 2012; 2:19159. [PMID: 23882380 PMCID: PMC3714072 DOI: 10.3402/jchimp.v2i3.19159] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2012] [Revised: 09/03/2012] [Accepted: 09/05/2012] [Indexed: 11/26/2022] Open
Abstract
Superior vena cava (SVC) syndrome is an unusual complication of pacemaker and implantable cardioverter–defibrillator implantation. It is believed to be due to SVC thrombosis with or without stenosis induced by endothelial disruption from repeated mechanical trauma by the leads. A 58-year-old man presented with gradual swelling of his face, neck, and upper extremities of 10 days duration. A pacemaker had been implanted for symptomatic bradycardia over 5 years ago. Venous Doppler and venogram revealed thrombosis and stenosis of the SVC. He was treated with multimodal therapy and was discharged with complete resolution of his symptoms.
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34
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Tait C, Baglin T, Watson H, Laffan M, Makris M, Perry D, Keeling D. Guidelines on the investigation and management of venous thrombosis at unusual sites. Br J Haematol 2012; 159:28-38. [PMID: 22881455 DOI: 10.1111/j.1365-2141.2012.09249.x] [Citation(s) in RCA: 96] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2012] [Accepted: 06/25/2012] [Indexed: 12/13/2022]
Affiliation(s)
- Campbell Tait
- Department of Haematology, Glasgow Royal Infirmary, Glasgow, UK
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35
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Tunneled Dialysis Catheter and Pacemaker Leads Determining Superior Vena Cava Syndrome. J Vasc Access 2011; 12:271-2. [DOI: 10.5301/jva.2011.6411] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/30/2010] [Indexed: 11/20/2022] Open
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36
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Mulz JM, Kraus MS, Thompson M, Flanders JA. Cranial vena caval syndrome secondary to central venous obstruction associated with a pacemaker lead in a dog. J Vet Cardiol 2010; 12:217-23. [DOI: 10.1016/j.jvc.2010.09.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2009] [Revised: 09/01/2010] [Accepted: 09/07/2010] [Indexed: 10/18/2022]
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37
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Maagh P, Butz T, Ziegler A, Meissner A, Prull MW, Trappe HJ. The first three-dimensional visualization of a thrombus in transit trapped between the leads of a permanent dual-chamber pacemaker: a case report. J Med Case Rep 2010; 4:359. [PMID: 21070629 PMCID: PMC2994880 DOI: 10.1186/1752-1947-4-359] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2010] [Accepted: 11/11/2010] [Indexed: 11/14/2022] Open
Abstract
Introduction Two-dimensional echocardiography is a useful tool in diagnosing cardiac masses. However, the three-dimensional offline reconstruction technique of transesophageal echocardiography might be superior to two-dimensional transesophageal echocardiography in providing additional information of structural details. Case presentation We report the case of a 76-year-old Caucasian man with a permanent dual-chamber pacemaker and a worm-like right-heart thrombus in transit. Two-dimensional transthoracic echocardiography and two-dimensional transesophageal echocardiography showed that it was debatable as to whether "the worm" was originating from the leads. Offline three-dimensional transesophageal echocardiography reconstruction technique proved superior in identifying the cardiac mass as a thrombus trapped between the leads of the pacemaker. The thrombus was successfully dissolved by systemic heparin therapy. Conclusions The three-dimensional transesophageal echocardiography is useful and effective in patients with implanted pacemakers or defibrillators when other closely competing imaging modalities are contraindicated, such as magnetic resonance imaging. In patients with pacemakers and trapped thrombus in transit for whom surgical therapy might be a high risk, medical therapy seems to offer a safer and convincing alternative. Whether the management of right-heart thrombi has to be modified due to the presence of pacemaker leads is controversial.
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Affiliation(s)
- Petra Maagh
- Department of Cardiology and Angiology, Ruhr-University Bochum/Germany, Hölkeskampring 40, 45625 Herne, Germany.
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38
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Feuchter AC, Katz KD. Right atrial thrombus secondary to pacemaker wires. J Emerg Med 2010; 43:e185-7. [PMID: 20656436 DOI: 10.1016/j.jemermed.2010.04.047] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2009] [Revised: 01/19/2010] [Accepted: 04/11/2010] [Indexed: 10/19/2022]
Abstract
BACKGROUND Pacemaker-induced right atrial thrombus is a rare condition that has not been described in the Emergency Medicine literature. This is a potentially fatal condition that is diagnosed with an echocardiogram and treated with surgical removal, thrombolytics, or long-term anticoagulation. OBJECTIVES This case report is designed to increase awareness among emergency physicians of this potentially fatal condition. CASE REPORT We describe the case of a patient with a massive right atrial thrombus secondary to pacemaker wire who presented to the Emergency Department with syncope, bradycardia, and rapid hemodynamic deterioration. CONCLUSION Emergency physicians should be aware of this life-threatening entity. Emergency bedside cardiac ultrasound or echocardiogram may be of value in its early identification.
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Affiliation(s)
- Alexander C Feuchter
- University of Pittsburgh Affiliated Residency in Emergency Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA
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39
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Murray JD, O’Sullivan ML, Hawkes KC. Cranial Vena Caval Thrombosis Associated With Endocardial Pacing Leads in Three Dogs. J Am Anim Hosp Assoc 2010; 46:186-92. [DOI: 10.5326/0460186] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Three dogs were examined several years following implantation of transvenous, single-lead, endocardial, right-ventricular permanent pacing systems for signs consistent with cranial vena caval syndrome. Angiograms performed in all dogs revealed filling defects within the cranial vena cava and, in some instances, intracardiac filling defects. Medical therapy was instituted in two dogs, with one surviving several weeks. One dog underwent surgery to address intra-cardiac thrombosis but did not survive the immediate postoperative period. Postmortem examinations were performed in two dogs and confirmed cranial vena caval and intracardiac thrombosis. Cranial vena caval thrombosis associated with transvenous pacing leads appears to carry significant morbidity and mortality.
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Affiliation(s)
- John D. Murray
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, Ontario N1G 2W1 Canada
- From the
| | - M. Lynne O’Sullivan
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, Ontario N1G 2W1 Canada
- From the
| | - Kimberley C.E. Hawkes
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, Ontario N1G 2W1 Canada
- From the
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RILEY ROBERTF, PETERSEN STEFFENE, FERGUSON JOHND, BASHIR YAVER. Managing Superior Vena Cava Syndrome as a Complication of Pacemaker Implantation: A Pooled Analysis of Clinical Practice. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2010; 33:420-5. [DOI: 10.1111/j.1540-8159.2009.02613.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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41
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Korkeila P, Mustonen P, Koistinen J, Nyman K, Ylitalo A, Karjalainen P, Lund J, Airaksinen J. Clinical and laboratory risk factors of thrombotic complications after pacemaker implantation: a prospective study. Europace 2010; 12:817-24. [DOI: 10.1093/europace/euq075] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
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42
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Acet H, Duygu H, Ertas F, Nazli C, Ergene O. A case of the giant thrombus on atrial lead of a patient who has a DDD permanent pacemaker. Clin Appl Thromb Hemost 2010; 17:346-7. [PMID: 20211926 DOI: 10.1177/1076029610363131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
We report a case of the giant thrombus on atrial lead of a patient who has a DDD dual-chamber permanent pacemaker.
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Affiliation(s)
- Halit Acet
- Department of Cardiology, Ataturk Training and Research Hospital, Izmir, Turkey
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43
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RANJAN RAVI, HENRIKSON CHARLESA. ICD Implantation after Crossing a Totally Occluded Subclavian Vein Via Collaterals from the Superior Vena Cava. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2010; 33:e14-6. [DOI: 10.1111/j.1540-8159.2009.02582.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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44
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Cunningham SM, Ames MK, Rush JE, Rozanski EA. Successful treatment of pacemaker-induced stricture and thrombosis of the cranial vena cava in two dogs by use of anticoagulants and balloon venoplasty. J Am Vet Med Assoc 2009; 235:1467-73. [DOI: 10.2460/javma.235.12.1467] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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45
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Allaqaband S, Kirvaitis R, Jan F, Bajwa T. Endovascular treatment of peripheral vascular disease. Curr Probl Cardiol 2009; 34:359-476. [PMID: 19664498 DOI: 10.1016/j.cpcardiol.2009.05.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Peripheral arterial disease (PAD) affects about 27 million people in North America and Europe, accounting for up to 413,000 hospitalizations per year with 88,000 hospitalizations involving the lower extremities and 28,000 involving embolectomy or thrombectomy of lower limb arteries. Many patients are asymptomatic and, among symptomatic patients, atypical symptoms are more common than classic claudication. Peripheral arterial disease also correlates strongly with risk of major cardiovascular events, and patients with PAD have a high prevalence of coexistent coronary and cerebrovascular disease. Because the prevalence of PAD increases progressively with age, PAD is a growing clinical problem due to the increasingly aged population in the United States and other developed countries. Until recently, vascular surgical procedures were the only alternative to medical therapy in such patients. Today, endovascular practice, percutaneous transluminal angioplasty with or without stenting, is used far more frequently for all types of lower extremity occlusive lesions, reflecting the continuing advances in imaging techniques, angioplasty equipment, and endovascular expertise. The role of endovascular intervention in the treatment of limb-threatening ischemia is also expanding, and its promise of limb salvage and symptom relief with reduced morbidity and mortality makes percutaneous transluminal angioplasty/stenting an attractive alternative to surgery and, as most endovascular interventions are performed on an outpatient basis, hospital costs are cut considerably. In this monograph we discuss current endovascular intervention for treatment of occlusive PAD, aneurysmal arterial disease, and venous occlusive disease.
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Pipili C, Cholongitas E, Tzanatos H. Two Cases of Silent Superior Vena Cava Syndrome associated with Vascular access and End-Stage Renal Disease. Int J Artif Organs 2009; 32:883-8. [DOI: 10.1177/039139880903201207] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Due to the unavoidable use of indwelling devices and the magnitude of the operative problems encountered, Superior Vena Cava Syndrome (SVCS) has become a serious threat for patients with a history of multiple catheter placements. True diagnosis sometimes is not available due to paucity of symptoms or due to the inadequate considerations of the disease. Particularly in patients with chronic kidney disease, the evidence of central venous occlusion dictates the avoidance of placing peripheral dialysis access in this extremity. In this article, we report two patients (case 1- a patient with end stage renal disease and case 2 - a patient with chronic kidney disease) with silent SVCS related to stenosis resulting from indwelling pacemaker leads. Furthermore, the first patient had an extrinsic factor of compression, a brachial artery pseudoaneurysm - which although it was not causative - it may certainly have contributed to the development of SVCS. The brachial artery pseudoaneurysm restricted even more the flow to cephalic vein and consequently to superior vena cava. Though pacemaker leads have been well identified previously in the literature as a cause of the SVCS, the brachial artery pseudoaneurysm causing extrinsic compression constitutes a novel factor. Through the publication of this paper the awareness of SVCS in these patients shall be definitely enhanced. Moreover, physicians, nurses and patients shall be educated regarding the requirement for peripheral vein presentation in chronic kidney disease.
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Affiliation(s)
- Chrisoula Pipili
- Department of Internal Medicine, General Hospital of Sitia, Sitia - Greece
- Department of Nephrology, Aretaieion University Hospital, Athens - Greece
| | | | - Helen Tzanatos
- Department of Nephrology, Aretaieion University Hospital, Athens - Greece
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A case of pacing lead induced clinical superior vena cava syndrome: a case report. CASES JOURNAL 2009; 2:7477. [PMID: 19829974 PMCID: PMC2740201 DOI: 10.4076/1757-1626-2-7477] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/26/2009] [Accepted: 05/16/2009] [Indexed: 11/24/2022]
Abstract
Introduction Transvenous pacing is a relatively safe treatment with a low complication rate, but serious thromboembolic complications have been reported to occur in 0.6% to 3.5% of cases. Superior vena cava obstruction syndrome is generally an uncommon but serious complication occurring in <0.1% of patients. However, when it occurs it carries with it significant morbidity and mortality. Case presentation A 51-year-old lady with long history of DDD permanent pacemaker presented following a mechanical fall. She had no obvious injuries, and was hemodynamically stable. General examination revealed features suggestive of Superior vena caval obstruction which was later confirmed by imaging. She was treated with long term oral anticoagulation with good clinical improvement. Conclusion Superior vena cava obstruction in patients with transvenous pacing leads, although rare, is a well recognized complication. With growing elderly population and increasing number of procedures performed, more and more people with permanent pacemaker are likely to be encountered in clinical practice. One should carefully look for thromboembolic complications during follow-up in patients with transvenous pacemaker leads, as it has implications for future management and carries significant morbidity and mortality.
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Tugcu A, Yildirimturk O, Tayyareci Y, Sagbas E, Yazicioglu N, Aytekin S. Right atrial pacemaker lead thrombosis causing tricuspid inflow obstruction. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2009; 32:262-4. [PMID: 19170918 DOI: 10.1111/j.1540-8159.2008.02211.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
A 75-year-old man was admitted to our hospital with a complaint of progressive dyspnea with effort. The patient had a permanent pacemaker that was implanted 16 years ago. Transesophageal echocardiography revealed a large, mobile mass in the right atrium attaching to the insertion site of the atrial lead at the tricuspid valve level. Because of the size, mobility, and location of the mass, urgent surgical removal was considered. The mass was successfully removed. Histologic examination of the mass demonstrated a partially organized thrombus. The postoperative course was uneventful and the patient's symptoms improved remarkably after operation.
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Affiliation(s)
- Aylin Tugcu
- Department of Cardiology, Florence Nightingale Hospital, Istanbul, Turkey
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Fischer A, Love B, Hansalia R, Mehta D. Transfemoral Snaring and Stabilization of Pacemaker and Defibrillator Leads to Maintain Vascular Access During Lead Extraction. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2009; 32:336-9. [PMID: 19272063 DOI: 10.1111/j.1540-8159.2008.02241.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Avi Fischer
- Section of Electrophysiology, Mount Sinai Medical Center, One Gustave L. Levy Pl., New York, NY 10029, USA.
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Hildebrandt N, Stertmann W, Wehner M, Schneider I, Neu H, Schneider M. Dual Chamber Pacemaker Implantation in Dogs with Atrioventricular Block. J Vet Intern Med 2009; 23:31-8. [DOI: 10.1111/j.1939-1676.2008.0233.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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