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Knorr D, Bandorski D, Bogossian H, Iliodromitis K, Schiedat F, Karosiene Z, Mijic D, Lemke B, Seyfarth M, Voß S, Knippschild S, Aweimer A, Zarse M, Kloppe A, Botsios S. Cephalic Vein Cutdown Is Superior to Subclavian Puncture as Venous Access for Patients with Cardiac Implantable Devices after Long-Term Follow-Up. J Clin Med 2024; 13:1044. [PMID: 38398357 PMCID: PMC10888737 DOI: 10.3390/jcm13041044] [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: 12/27/2023] [Revised: 02/07/2024] [Accepted: 02/08/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Cephalic vein cutdown (CVC) and subclavian vein puncture (SVP) are the most commonly used access sites for transvenous lead placement of cardiac implantable electronic devices (CIEDs). Limited knowledge exists about the long-term patency of the vascular lumen housing the leads. METHODS Among the 2703 patients who underwent CIED procedures between 2005 and 2013, we evaluated the phlebographies of 162 patients scheduled for an elective CIED replacement (median of 6.4 years after the first operation). The phlebographies were divided into four stenosis types: Type I = 0%, Type II = 1-69%, Type III = 70-99%, and Type IV = occlusion. Due to the fact that no standardized stenosis categorization exists, experienced physicians in consensus with the involved team made the applied distribution. The primary endpoint was the occurrence of stenosis Type III or IV in the CVC group and in the SVP group. RESULTS In total, 162 patients with venography were enrolled in this study. The prevalence of high-degree stenosis was significantly lower in the CVC group (7/89, 7.8%) than in the SVP group (15/73, 20.5%, p = 0.023). In the CVC group, venographies showed a lower median stenosis (33%) than in the SVP group (median 42%). CONCLUSIONS The present study showed that the long-term patency of the subclavian vein is higher after CVC than after SVP for venous access in patients with CIED.
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Affiliation(s)
- Dario Knorr
- Department of Cardiology, University Witten/Herdecke, 58455 Witten, Germany; (D.K.); (K.I.); (M.S.); (M.Z.); (S.B.)
| | - Dirk Bandorski
- Faculty of Medicine, Semmelweis University, 1085 Budapest, Hungary;
| | - Harilaos Bogossian
- Department of Cardiology, University Witten/Herdecke, 58455 Witten, Germany; (D.K.); (K.I.); (M.S.); (M.Z.); (S.B.)
- Cardiology and Rhythmology, Ev. Krankenhaus Hagen, 58135 Hagen, Germany
| | - Konstantinos Iliodromitis
- Department of Cardiology, University Witten/Herdecke, 58455 Witten, Germany; (D.K.); (K.I.); (M.S.); (M.Z.); (S.B.)
- Cardiology and Rhythmology, Ev. Krankenhaus Hagen, 58135 Hagen, Germany
| | - Fabian Schiedat
- Department of Cardiology and Angiology, Bergmannsheil University Hospitals, Ruhr University of Bochum, 44789 Bochum, Germany; (F.S.); (A.A.); (A.K.)
- Department of Cardiology and Angiology, Marienhospital Gelsenkirchen, 45886 Gelsenkirchen, Germany
| | - Zana Karosiene
- Department of Cardiology, Elektrophysiology and Angiology, Klinikum Lüdenscheid, 58515 Luedenscheid, Germany; (Z.K.); (D.M.); (B.L.)
| | - Dejan Mijic
- Department of Cardiology, Elektrophysiology and Angiology, Klinikum Lüdenscheid, 58515 Luedenscheid, Germany; (Z.K.); (D.M.); (B.L.)
| | - Bernd Lemke
- Department of Cardiology, Elektrophysiology and Angiology, Klinikum Lüdenscheid, 58515 Luedenscheid, Germany; (Z.K.); (D.M.); (B.L.)
| | - Melchior Seyfarth
- Department of Cardiology, University Witten/Herdecke, 58455 Witten, Germany; (D.K.); (K.I.); (M.S.); (M.Z.); (S.B.)
- Department of Cardiology, Helios Klinikum Wuppertal, 42283 Wuppertal, Germany
| | - Sabrina Voß
- Faculty of Health, Institute for Medical Biometry and Epidemiology, Witten/Herdecke University, 58455 Witten, Germany (S.K.)
| | - Stephanie Knippschild
- Faculty of Health, Institute for Medical Biometry and Epidemiology, Witten/Herdecke University, 58455 Witten, Germany (S.K.)
| | - Assem Aweimer
- Department of Cardiology and Angiology, Bergmannsheil University Hospitals, Ruhr University of Bochum, 44789 Bochum, Germany; (F.S.); (A.A.); (A.K.)
| | - Markus Zarse
- Department of Cardiology, University Witten/Herdecke, 58455 Witten, Germany; (D.K.); (K.I.); (M.S.); (M.Z.); (S.B.)
- Department of Cardiology, Elektrophysiology and Angiology, Klinikum Lüdenscheid, 58515 Luedenscheid, Germany; (Z.K.); (D.M.); (B.L.)
| | - Axel Kloppe
- Department of Cardiology and Angiology, Bergmannsheil University Hospitals, Ruhr University of Bochum, 44789 Bochum, Germany; (F.S.); (A.A.); (A.K.)
- Department of Cardiology and Angiology, Marienhospital Gelsenkirchen, 45886 Gelsenkirchen, Germany
| | - Spiridon Botsios
- Department of Cardiology, University Witten/Herdecke, 58455 Witten, Germany; (D.K.); (K.I.); (M.S.); (M.Z.); (S.B.)
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