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Lipšic E, Daniëls F, Groenveld HF, Rienstra M, Maass AH. When and how to perform venoplasty for lead placement. Heart Rhythm 2024:S1547-5271(24)02522-0. [PMID: 38692339 DOI: 10.1016/j.hrthm.2024.04.088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 04/14/2024] [Accepted: 04/24/2024] [Indexed: 05/03/2024]
Abstract
Because of the increasing use of cardiac implantable electronic devices (CIEDs) with one or more intracardiac electrodes, the rate of lead failure is increasing. Moreover, upgrade of the CIED frequently is indicated for cardiac resynchronization therapy or other reasons. Both these situations require a new intervention, preferably using ipsilateral venous access. However, venous obstruction after CIED insertion occurs in 10%-20% of patients and poses a major obstacle for implantation of additional leads. Possible solutions include lead extraction, contralateral lead insertion, and venoplasty. Preprocedural venoplasty is associated with the lowest short- and long-term risks. Here we describe a step-by-step approach to this technique, which can be introduced and safely performed in most interventional catheterization laboratories.
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Affiliation(s)
- Erik Lipšic
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
| | - Fenna Daniëls
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Hessel F Groenveld
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Michiel Rienstra
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Alexander H Maass
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Yousuf Q, Rashid A, Hafeez I, Rather H, Syed I, Mir AH, Mir SA, Lone A. Prevalence and Predictors of Venous Stenosis Following First Transvenous Cardiac Implantable Electronic Device Implantation. J Saudi Heart Assoc 2023; 35:301-310. [PMID: 38116403 PMCID: PMC10727134 DOI: 10.37616/2212-5043.1358] [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: 09/17/2023] [Revised: 10/21/2023] [Accepted: 11/01/2023] [Indexed: 12/21/2023] Open
Abstract
Objectives Very few studies have been done on Venous stenosis following the first transvenous cardiac device implantation. We aimed to assess the prevalence and predictors of Venous stenosis/Occlusion following the first transvenous cardiac device implantation with venous angiography at one year of follow-up. Methods This study was a single-center prospective, observational study. Demographic, clinical, procedural, and device data was collected. All patients underwent a preimplant contrast and repeated venography at twelve months to look for upper limb venous anatomy, obstruction, or collaterals. Results A total of 146 patients were included in the final analysis. 60 (41 %) patients developed some degree of venous stenosis. Most patients had mild to moderate stenosis, and almost all were asymptomatic. Among patient-related factors increasing age (64.66 ± 10.07 vs 60.91 ± 11.94 years p = 0.04), presence of hypertension (50.5 % vs 19.6 % p = 0.0004), diabetes (73 % vs 29.6 % p = 0.000) and dyslipidemia (66.7 % vs 36.3 p = 0.009) were significantly associated with Venous stenosis/occlusion. Among procedure-related factors, larger total lead diameter (3.88 ± 1.09 vs. 3.50 ± 1.03 mm p = 0.03) and implantation of biventricular devices (p = 0.0037) seem to be significantly associated with venous obstruction. In logistic regression analysis, hypertension (p = 0.018), total lead diameter (p = 0.024), and use of CRT-P/CRTD/ICD (p = 0.03) remained significant predictors of severe venous stenosis. Conclusions Our study demonstrates venous obstruction in 40 % of cardiac implantable electronic device patients at one-year follow-up. Most patients have mild to moderate stenosis, and almost all are asymptomatic. Increasing age, hypertension, diabetes, dyslipidemia, larger total lead diameter, and implantation of biventricular devices are significantly associated with venous obstruction.
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Affiliation(s)
- Qayoom Yousuf
- Department of Cardiology, SKIMS Soura, Srinagar, J&K,
India
| | - Aamir Rashid
- Department of Cardiology, SKIMS Soura, Srinagar, J&K,
India
| | - Imran Hafeez
- Department of Cardiology, SKIMS Soura, Srinagar, J&K,
India
| | - Hilal Rather
- Department of Cardiology, SKIMS Soura, Srinagar, J&K,
India
| | - Ishrath Syed
- Department of Medicine, SKIMS Soura, Srinagar, J&K,
India
| | - Altaf H. Mir
- Department of Anesthesiology, SKIMS Soura, Srinagar, J&K,
India
| | - Suheel A. Mir
- Department of Cardiology, SKIMS Soura, Srinagar, J&K,
India
| | - Ajaz Lone
- Department of Cardiology, SKIMS Soura, Srinagar, J&K,
India
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Carrington M, António PS, Rodrigues N, Nunes-Ferreira A, Bernardes A, Pinto FJ, Sousa JD, Marques P. New Technique for Preserving Cephalic Vein Flow in Pacemaker Implantation Ipsilateral to Arteriovenous Fistula. Arq Bras Cardiol 2023; 120:e20220926. [PMID: 37377197 DOI: 10.36660/abc.20220926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 03/08/2023] [Indexed: 06/29/2023] Open
Affiliation(s)
- Mafalda Carrington
- Serviço de Cardiologia, Hospital do Espírito Santo de Évora, Évora - Portugal
| | - Pedro Silvério António
- Serviço de Cardiologia, Departamento de Coração e Vasos, Centro Hospitalar Universitário de Lisboa Norte, Lisboa - Portugal
- Centro Acadêmico de Medicina de Lisboa (CAML), Centro Cardiovascular da Universidade de Lisboa, Faculdade de Medicina de Lisboa, Lisboa - Portugal
| | - Natacha Rodrigues
- Serviço de Nefrologia e Transplante Renal, Departamento de Medicina, Centro Hospitalar Universitário de Lisboa Norte, Lisboa - Portugal
| | - Afonso Nunes-Ferreira
- Serviço de Cardiologia, Departamento de Coração e Vasos, Centro Hospitalar Universitário de Lisboa Norte, Lisboa - Portugal
- Centro Acadêmico de Medicina de Lisboa (CAML), Centro Cardiovascular da Universidade de Lisboa, Faculdade de Medicina de Lisboa, Lisboa - Portugal
| | - Ana Bernardes
- Serviço de Cardiologia, Departamento de Coração e Vasos, Centro Hospitalar Universitário de Lisboa Norte, Lisboa - Portugal
- Centro Acadêmico de Medicina de Lisboa (CAML), Centro Cardiovascular da Universidade de Lisboa, Faculdade de Medicina de Lisboa, Lisboa - Portugal
| | - Fausto J Pinto
- Serviço de Cardiologia, Departamento de Coração e Vasos, Centro Hospitalar Universitário de Lisboa Norte, Lisboa - Portugal
- Centro Acadêmico de Medicina de Lisboa (CAML), Centro Cardiovascular da Universidade de Lisboa, Faculdade de Medicina de Lisboa, Lisboa - Portugal
| | - João de Sousa
- Serviço de Cardiologia, Departamento de Coração e Vasos, Centro Hospitalar Universitário de Lisboa Norte, Lisboa - Portugal
- Centro Acadêmico de Medicina de Lisboa (CAML), Centro Cardiovascular da Universidade de Lisboa, Faculdade de Medicina de Lisboa, Lisboa - Portugal
| | - Pedro Marques
- Serviço de Cardiologia, Departamento de Coração e Vasos, Centro Hospitalar Universitário de Lisboa Norte, Lisboa - Portugal
- Centro Acadêmico de Medicina de Lisboa (CAML), Centro Cardiovascular da Universidade de Lisboa, Faculdade de Medicina de Lisboa, Lisboa - Portugal
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Ferro EG, Kramer DB, Li S, Locke AH, Misra S, Schmaier AA, Carroll BJ, Song Y, D'Avila AA, Yeh RW, Zimetbaum PJ, Secemsky EA. Incidence, Treatment, and Outcomes of Symptomatic Device Lead-Related Venous Obstruction. J Am Coll Cardiol 2023:S0735-1097(23)05427-X. [PMID: 37204378 DOI: 10.1016/j.jacc.2023.04.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 04/06/2023] [Indexed: 05/20/2023]
Abstract
BACKGROUND The incidence and clinical impact of lead-related venous obstruction (LRVO) among patients with cardiovascular implantable electronic devices (CIEDs) is poorly defined. OBJECTIVES The objectives of this study were to determine the incidence of symptomatic LRVO after CIED implant; describe patterns in CIED extraction and revascularization; and quantify LRVO-related health care utilization based on each type of intervention. METHODS LRVO status was defined among Medicare beneficiaries after CIED implant from October 1, 2015, to December 31, 2020. Cumulative incidence functions of LRVO were estimated by Fine-Gray methods. LRVO predictors were identified using Cox regression. Incidence rates for LRVO-related health care visits were calculated with Poisson models. RESULTS Among 649,524 patients who underwent CIED implant, 28,214 developed LRVO, with 5.0% cumulative incidence at maximum follow-up of 5.2 years. Independent predictors of LRVO included CIEDs with >1 lead (HR: 1.09; 95% CI: 1.07-1.15), chronic kidney disease (HR: 1.17; 95% CI: 1.14-1.20), and malignancies (HR: 1.23; 95% CI: 1.20-1.27). Most patients with LRVO (85.2%) were managed conservatively. Among 4,186 (14.8%) patients undergoing intervention, 74.0% underwent CIED extraction and 26.0% percutaneous revascularization. Notably, 90% of the patients did not receive another CIED after extraction, with low use (2.2%) of leadless pacemakers. In adjusted models, extraction was associated with significant reductions in LRVO-related health care utilization (adjusted rate ratio: 0.58; 95% CI: 0.52-0.66) compared with conservative management. CONCLUSIONS In a large nationwide sample, the incidence of LRVO was substantial, affecting 1 of every 20 patients with CIEDs. Device extraction was the most common intervention and was associated with long-term reduction in recurrent health care utilization.
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Affiliation(s)
- Enrico G Ferro
- Richard A. and Susan F. Smith Center for Outcomes Research, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA; Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Daniel B Kramer
- Richard A. and Susan F. Smith Center for Outcomes Research, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA; Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Siling Li
- Richard A. and Susan F. Smith Center for Outcomes Research, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Andrew H Locke
- Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Shantum Misra
- Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Alec A Schmaier
- Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Brett J Carroll
- Richard A. and Susan F. Smith Center for Outcomes Research, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA; Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Yang Song
- Richard A. and Susan F. Smith Center for Outcomes Research, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Andre A D'Avila
- Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Robert W Yeh
- Richard A. and Susan F. Smith Center for Outcomes Research, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA; Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Peter J Zimetbaum
- Richard A. and Susan F. Smith Center for Outcomes Research, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA; Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
| | - Eric A Secemsky
- Richard A. and Susan F. Smith Center for Outcomes Research, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA; Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
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Kellnar A, Fichtner S, Reitinger P, Sadoni S, Heyn O, Sams L, Estner HL, Lackermair K. Prevalence, management, and prediction of venous access site occlusion in patients undergoing lead revision surgery. Int J Cardiol 2023; 381:16-19. [PMID: 37044179 DOI: 10.1016/j.ijcard.2023.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 03/13/2023] [Accepted: 04/07/2023] [Indexed: 04/14/2023]
Abstract
BACKGROUND Implantable electronic cardiac devices (CIED) have emerged as an essential component in the treatment of cardiac arrhythmias and heart failure. Due to increased life expectancy, expanding indications and limited technical survival, an increasing number of revision procedures can be anticipated. Venous access site occlusion (VASO) is the main obstacle during revision surgery. In this retrospective study we evaluated the prevalence, predictive parameters and operative management of venous access site occlusion. METHODS AND RESULTS Between 01/2016 and 12/2020 304 patients underwent lead revision surgery of transvenous CIED in our department. Prevalence of VASO was 25.7% (n = 78), one patient was symptomatic. Independent predicting clinical parameters were male sex (2.86 (1.39-5.87), p < 0.01) and lead age (1.11 (1.05-1.18), p < 0.01)). Revision surgery despite VASO was successful in 97.4% (n = 76) without prolongation of the total surgery time or higher complication rates. Yet, lead extraction was possible in 92% of patients with VASO vs. 98.2% of patients without VASO (p 0.01). CONCLUSION VASO is a frequent condition in patients undergoing lead revision surgery, but successful revision is feasible in most cases without preceding lead extraction. However, the lower success rates of lead extractions may be prognostically relevant, especially for younger patients.
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Affiliation(s)
- Antonia Kellnar
- Department of Medicine I, University Hospital Munich, Ludwig Maximilians University, Munich, Germany.
| | | | - Philipp Reitinger
- Department of Medicine I, University Hospital Munich, Ludwig Maximilians University, Munich, Germany
| | - Sebastian Sadoni
- Department of Cardiac Surgery, University Hospital Munich, Ludwig Maximilians University, Munich, Germany
| | - Oliver Heyn
- Department of Cardiac Surgery, University Hospital Munich, Ludwig Maximilians University, Munich, Germany
| | - Lauren Sams
- Department of Medicine I, University Hospital Munich, Ludwig Maximilians University, Munich, Germany
| | - Heidi L Estner
- Department of Medicine I, University Hospital Munich, Ludwig Maximilians University, Munich, Germany
| | - Korbinian Lackermair
- Department of Medicine I, University Hospital Munich, Ludwig Maximilians University, Munich, Germany
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Domenichini G, Le Bloa M, Carroz P, Graf D, Herrera-Siklody C, Teres C, Porretta AP, Pascale P, Pruvot E. New Insights in Central Venous Disorders. The Role of Transvenous Lead Extractions. Front Cardiovasc Med 2022; 9:783576. [PMID: 35282352 PMCID: PMC8904723 DOI: 10.3389/fcvm.2022.783576] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Accepted: 01/24/2022] [Indexed: 11/13/2022] Open
Abstract
Over the last decades, the implementation of new technology in cardiac pacemakers and defibrillators as well as the increasing life expectancy have been associated with a higher incidence of transvenous lead complications over time. Variable degrees of venous stenosis at the level of the subclavian vein, the innominate trunk and the superior vena cava are reported in up to 50% of implanted patients. Importantly, the number of implanted leads seems to be the main risk factor for such complications. Extraction of abandoned or dysfunctional leads is a potential solution to overcome venous stenosis in case of device upgrades requiring additional leads, but also, in addition to venous angioplasty and stenting, to reduce symptoms related to the venous stenosis itself, i.e., the superior vena cava syndrome. This review explores the role of transvenous lead extraction procedures as therapeutical option in case of central venous disorders related to transvenous cardiac leads. We also describe the different extraction techniques available and other clinical indications for lead extractions such as lead infections. Finally, we discuss the alternative therapeutic options for cardiac stimulation or defibrillation in case of chronic venous occlusions that preclude the implant of conventional transvenous cardiac devices.
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Zimetbaum P, Carroll BJ, Locke AH, Secemsky E, Schermerhorn M. Lead-Related Venous Obstruction in Patients With Implanted Cardiac Devices. J Am Coll Cardiol 2022; 79:299-308. [DOI: 10.1016/j.jacc.2021.11.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 11/02/2021] [Accepted: 11/03/2021] [Indexed: 11/27/2022]
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Tonko JB, Black SA, Rinaldi CA. "Inside-Out" Central Venous Access approach with infraclavicular exit for right-sided CRT-D Implantation in bilateral brachiocephalic and superior vena cava occlusion. Clin Case Rep 2021; 9:CCR33980. [PMID: 34136221 PMCID: PMC8190511 DOI: 10.1002/ccr3.3980] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 01/09/2021] [Accepted: 02/08/2021] [Indexed: 11/08/2022] Open
Abstract
The use of the "inside-out" approach with an infraclavicular exit site with a dedicated system in the presence of complex central venous occlusion is feasible and safe for the implantation of complex cardiac devices.
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Affiliation(s)
- Johanna B. Tonko
- Department of CardiologySt. Thomas HospitalLondonUK
- Faculty of Life Sciences and MedicineKing’s College LondonLondonUK
| | | | - Christopher A. Rinaldi
- Department of CardiologySt. Thomas HospitalLondonUK
- Faculty of Life Sciences and MedicineKing’s College LondonLondonUK
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Zheng ZP, Zhang W, Zeng ZH, Zheng JY. Strategy of pacemaker and electrode replacement for superior vena cava stenosis. J Int Med Res 2021; 49:300060520945170. [PMID: 33445982 PMCID: PMC7812412 DOI: 10.1177/0300060520945170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Accepted: 07/03/2020] [Indexed: 11/16/2022] Open
Abstract
Cardiac implantable devices are commonly used for superior vena cava stenosis, but there have been few reports of electrode replacement in the stenosed superior vena cava. A 73-year-old man was diagnosed with second-degree type II atrioventricular block and a permanent dual-chamber, rate-modulated pacing pacemaker was implanted 10 years previously. Because of depletion of the pacemaker battery and an increase in the ventricular pacing threshold, replacement of the pacemaker and ventricular electrode was required. During the operation, we found that the patient had severe superior vena cava stenosis on angiography, and this caused obstruction when a common guidewire was used to pass through the superior vena cava. After attempting various methods, we successfully passed through the vascular stenosis with a super slide guidewire and a long sheath, and completed replacement of the pacemaker and ventricular electrode. We summarize the related literature of superior vena cava stenosis related to a cardiac implantable device, and discuss the replacement strategy of this complication and other treatment options.
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Affiliation(s)
| | - Wei Zhang
- Wei Zhang, Department of Cardiovascular, The First Affiliated Hospital of Guangdong Pharmaceutical University, No. 19 Nonglinxia Road, Yuexiu District, Guangzhou, Guangdong 510080, China.
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Cacko A, Kozyra-Pydyś E, Gawałko M, Opolski G, Grabowski M. The role of hemostatic markers as venous stenosis or occlusion predictors following first transvenous cardiac device implantation. Cardiol J 2019; 28:690-696. [PMID: 30912577 DOI: 10.5603/cj.a2019.0030] [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: 09/28/2018] [Revised: 01/14/2019] [Accepted: 02/07/2019] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Among patients with an implanted cardiac implantable electronic device (CIED), ipsilateral upper extremity vein stenosis or occlusion (VSO) is observed more frequently than in the general population. However, there are no data available concerning the relationship between hemostatic markers (and their dynamics) and the occurrence of VSO. The aim of this study was to assess the predictive value of beta-thromboglobulin, the von Willebrand factor (vWF), fibrynogen and D-dimer for VSO development among first time CIED recipients. METHODS This is a single-center, prospective study of consecutive first time CIED recipients without upper extremity VSO in baseline ultrasound examination. Biochemical data were collected from all the patients before CIED implantation (first measuring), up to 7 days subsequent (second measuring) and 6 months after the operation (third measuring). Primary endpoint was defined as the presence of upper extremity VSO at the implantation site during the ultrasound examination 6 months after the operation. RESULTS The study included 71 patients (mean age 73.1 ± 10.5 years; 39 [55%] male). The incidence of VSO within 6-months follow up was 21.1%. Average concentrations of hemostatic markers increased significantly in all patients immediately after CIED implantation. Serial hemostatic marker concentrations were similar in patients who met or did not meet the primary endpoint, apart from vWF. The mean concentration was significantly elevated in the group of 15 patients who reached the primary endpoint (p = 0.032). CONCLUSIONS A significant increase in vWF concentration at 6 months post implantation may be a marker for VSO occurrence.
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Affiliation(s)
- Andrzej Cacko
- Department of Medical Informatics and Telemedicine, Medical University of Warsaw, Poland
| | | | - Monika Gawałko
- 1st Department of Cardiology, Medical University of Warsaw, Poland
| | - Grzegorz Opolski
- 1st Department of Cardiology, Medical University of Warsaw, Poland
| | - Marcin Grabowski
- 1st Department of Cardiology, Medical University of Warsaw, Poland.
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