Venous Thrombosis and Stenosis After Implantation of Pacemakers and Defibrillators

  • Grzegorz Rozmus
  • James P. Daubert
  • David T. Huang
  • Spencer Rosero
  • Burr Hall
  • Charles Francis
Review

Abstract

Venous complications of pacemaker/ implantable cardioverter defibrillator (ICD) system implantation rarely cause immediate clinical problems. The challenge starts when patients come for system revision or upgrade. Numerous reports of venous complications such as stenosis, occlusions, and superior vena cava syndrome have been published. We reviewed current knowledge of these complications, management, and their impact on upgrade/revision procedures. One study has suggested that intravenous lead infection promotes local vein stenosis. Another found that the presence of a temporary wire before implantation is associated with an increased risk of stenosis. Although data for ICD leads is based only on three studies—it suggests that the rate of venous complications is very similar to that of pacing systems, and probably data from pacing leads can be extrapolated to ICD leads. Despite 40 years of experience with transcutaneous implanted intravenous pacing systems and dozens of studies, we were unable to identify clear risk factors (confirmed by independent studies) that lead to venous stenosis. Neither the hardware (lead size, number and material) nor the access site choice (cephalic cut down, subclavian or axillary puncture) appears to affect rate of venous complications. A few factors were proposed as predictors of severe venous stenosis/occlusion: presence of multiple pacemaker leads (compared to a single lead), use of hormone therapy, personal history of venous thrombosis, the presence of temporary wire before implantation, previous presence of a pacemaker (ICD as an upgrade) and the use of dual-coil leads. Anticoagulant therapy (for other reasons than pacemaker lead) seemed to have protective antithrombotic effect.

pacemaker implantable defibrillator thrombosis stenosis complications 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Stoney WS, Addlestone RB, Alford WC Jr, Burrus GR, Frist RA, Thomas CS Jr. The incidence of venous thrombosis following long-term transvenous pacing. Ann Thorac Surg 1976;22(2):166–170.PubMedGoogle Scholar
  2. 2.
    Crook BR, Gishen P, Robinson CR, Oram S. Occlusion of the subclavian vein associated with cephalic vein pacemaker electrodes. Br J Surg 1977;64(5):329–331.Google Scholar
  3. 3.
    American Heart Association. Heart Disease and Stroke Statistisc–2004 Update. Dallas, Tex.: American Heart Association, 2003.Google Scholar
  4. 4.
    Higgins SL. automatic implantable cardiac defibrillators. Curr Treat Options Cardiovasc Med 2002;4:287–293.PubMedGoogle Scholar
  5. 5.
    Meisner R. World Wide Medtronic marketing estimates from historical industry implants, patient mortality, and device registry database. Personal communication, August 30, 2004.Google Scholar
  6. 6.
    Spittell PC, Hayes DL. Venous complications after insertion of a transvenous pacemaker. Mayo Clin Proc 1992;67:258–265.PubMedGoogle Scholar
  7. 7.
    Hill SL, Berry RE. Subclavian vein thrombosis: A continuing challenge. Surgery 1990;108:1–9.PubMedGoogle Scholar
  8. 8.
    Demeter SL, Pritchard JS, Piedad OH, et al. Upper extremity thrombosis: Etiology and prognosis. Angiology 1982;33:743–755.PubMedGoogle Scholar
  9. 9.
    Tilney NL, Griffiths HJG, Edwards EA. Natural history of major venous thrombosis of the upper extremity. Arch Surg 1970;101:792–796.PubMedGoogle Scholar
  10. 10.
    Sethi GK, Bhayana JN, Scott SM. Innominate venous thrombosis: A rare complication of transvenous pacemaker electrodes. Am Heart J 1974;87:770–772.CrossRefPubMedGoogle Scholar
  11. 11.
    Blackburn T, Dunn M. Pacemaker-induced superior vena cava syndrome: Consideration of management. Am Heart J 1988;116:893–896.CrossRefPubMedGoogle Scholar
  12. 12.
    Pauletti M, Pingitore R, Contini C. Superior vena cava stenosis at site of intersection of two pacing electrodes. Br Heart J 1979;42:487–489.PubMedGoogle Scholar
  13. 13.
    Haruko A, Kazuo T, Yasuhide N, Akio K. Effect of low dose aspirin on augmented plasminogen activator inhibitor Type 1 activity in patients with permanent pacemakers. PACE 1994;17:146–151.PubMedGoogle Scholar
  14. 14.
    Oginosawa Y, Abe H, Nakashima Y. The incidence and risk factors for venous obstruction after implantation of transvenous pacing leads. Pacing Clin Electrophysiol 2002;25:1605–1611.CrossRefPubMedGoogle Scholar
  15. 15.
    Da Costa SS, Scalabrini NA, Costa R, Caldas JG, Martinelli FM. Incidence and risk factors of upper extremity deep vein lesions after permanent transvenous pacemaker implant: A 6-month follow-up prospective study. Pacing Clin Electrophysiol 2002;25:1301–1306.CrossRefPubMedGoogle Scholar
  16. 16.
    Bracke F, Meijer A, Van Gelder B. Venous occlusion of the access vein in patients referred for lead extraction: Influence of patient and lead characteristics. Pacing Clin Electrophysiol 2003;26:1649–1652.CrossRefPubMedGoogle Scholar
  17. 17.
    Antonelli D, Turgeman Y, Kaveh Z, Artoul S, Rosenfeld T. Short-term thrombosis after transvenous permanent pacemaker insertion. Pacing Clin Electrophysiol 1989;12:280–282.PubMedGoogle Scholar
  18. 18.
    Goto Y, Abe T, Sekine S, Sakurada T. Long-term thrombosis after transvenous permanent pacemaker implantation. Pacing Clin Electrophysiol 1998;21:1192–1195.PubMedGoogle Scholar
  19. 19.
    Zuber M, Huber P, Fricker U, Buser P, Jager K. Assessment of the subclavian vein in patients with transvenous pacemaker leads. Pacing Clin Electrophysiol 1998;21:2621–2630.PubMedGoogle Scholar
  20. 20.
    van Rooden CJ, Molhoek SG, Rosendaal FR, Schalij MJ, Meinders AE, Huisman MV. Incidence and risk factors of early venous thrombosis associated with permanent pacemaker leads. J Cardiovasc Electrophysiol 2004;15:1258–1262.CrossRefPubMedGoogle Scholar
  21. 21.
    Calkins H, Ramza BM, Brinker J, Atiga W, Donahue K, Nsah E, Taylor E, Halperin H, Lawrence JH, Tomaselli G, Berger RD. Prospective randomized comparison of the safety and effectiveness of placement of endocardial pacemaker and defibrillator leads using the extrathoracic subclavian vein guided by contrast venography versus the cephalic approach. Pacing Clin Electrophysiol2001;24(4 Pt 1):456–464.CrossRefPubMedGoogle Scholar
  22. 22.
    Sticherling C, Chough SP, Baker RL, Wasmer K, Oral H, Tada H, Horwood L, Kim MH, Pelosi F, Michaud GF, Strickberger SA, Morady F, Knight BP. Prevalence of central venous occlusion in patients with chronic defibrillator leads. Am Heart J 2001;141:813–816.CrossRefPubMedGoogle Scholar
  23. 23.
    Lickfett L, Bitzen A, Arepally A, Nasir K, Wolpert C, Jeong KM, Krause U, Schimpf R, Lewalter T, Calkins H, Jung W, Luderitz B. Incidence of venous obstruction following insertion of an implantable cardioverter defibrillator. A study of systematic contrast venography on patients presenting for their first elective ICD generator replacement. Europace 2004;6:25–31.Google Scholar
  24. 24.
    Mazzetti H, Dussaut A, Tentori C, Dussaut E, Lazzari JO. Superior vena cava occlusion and/or syndrome related to pacemaker leads. Am Heart J 1993;125:831–837.CrossRefPubMedGoogle Scholar
  25. 25.
    Goudevenos JA, Reid PG, Adams PC, Holden MP, Williams DO. Pacemaker-induced superior vena cava syndrome: Report of four cases and review of the literature. Pacing Clin Electrophysiol 1989;12:1890–1895.PubMedGoogle Scholar
  26. 26.
    Barakat K, Robinson NM, Spurrell RA. Transvenous pacing lead-induced thrombosis: A series of cases with a review of the literature. Cardiology 2000;93:142–148.CrossRefPubMedGoogle Scholar
  27. 27.
    Chan AW, Bhatt DL, Wilkoff BL, Roffi M, Mukherjee D, Gray BH, Baizer CT, Yadav JS. Percutaneous treatment for pacemaker-associated superior vena cava syndrome. Pacing Clin Electrophysiol 2002;25:1628–1633.CrossRefPubMedGoogle Scholar
  28. 28.
    Prandoni P, Polistena P, Bernardi E, Cogo A, Casara D, Verlato F, Angelini F, Simioni P, Signorini GP, Benedetti L, Girolami A. Upper-extremity deep vein thrombosis. Risk factors, diagnosis, and complications. Arch Intern Med 1997;157:57–62.CrossRefPubMedGoogle Scholar
  29. 29.
    Harley DP, White RA, Nelson RJ, Mehringer CM. Pulmonary embolism secondary to venous thrombosis of the arm. Am J Surg 1984;104:561–567.Google Scholar
  30. 30.
    Monreal M, Lafoz E, Ruiz J, Valls R, Alastrue A., Upper-extremity deep venous thrombosis and pulmonary embolism. A prospective study. Chest 1991;99(2):280–283.Google Scholar
  31. 31.
    AbuRahma AF, Sadler D, Stuart P, Khan MZ, Boland JP. Conventional versus thrombolytic therapy in spontaneous (effort) axillary-subclavian vein thrombosis. Am J Surg 1991;161(4):459–465.CrossRefPubMedGoogle Scholar
  32. 32.
    Heron E, Lozinguez O, Emmerich J, Laurian C, Fiessinger JN. Long-term sequelae of spontaneous axillary-subclavian venous thrombosis. Ann Intern Med 1999;131(7):510–513.PubMedGoogle Scholar
  33. 33.
    Hingorani A, Ascher E, Lorenson E, DePippo P, Salles-Cunha S, Scheinman M, Yorkovich W, Hanson J. Upper extremity deep venous thrombosis and its impact on morbidity and mortality rates in a hospital-based population. J Vasc Surg 1997;26(5):853–860.PubMedGoogle Scholar
  34. 34.
    Nishino M, Tanouchi J, Ito T, Tanaka K, Aoyama T, Kitamura M, Nakagawa T, Kato J, Yamada Y. Echographic detection of latent severe thrombotic stenosis of the superior vena cava and innominate vein in patients with a pacemaker: Integrated diagnosis using sonography, pulse Doppler, and color flow. Pacing Clin Electrophysiol 1997;20(4 Pt 1):946–952.PubMedGoogle Scholar
  35. 35.
    Mustafa BO, Rathbun SW, Whitsett TL, Raskob GE. Sensitivity and specificity of ultrasonography in the diagnosis of upper extremity deep vein thrombosis: a systematic review. Arch Intern Med 2002,25;162(4):401–404.CrossRefPubMedGoogle Scholar
  36. 36.
    Baarslag HJ, van Beek EJ, Koopman MM, Reekers JA. Prospective study of color duplex ultrasonography compared with contrast venography in patients suspected of having deep venous thrombosis of the upper extremities. Ann Intern Med 2002;136(12):865–872.PubMedGoogle Scholar
  37. 37.
    Bettmann MA Noninvasive and venographic diagnosis of deep vein thrombosis. Cardiovasc Intervent Radiol 1988;11 (Suppl) S15–20.PubMedGoogle Scholar
  38. 38.
    Baldt MM, Zontsich T, Kainberger F, Fleischmann G, Mostbeck G. Spiral CT evaluation of deep venous thrombosis. Semin Ultrasound CT MR 1997;18:369–375.CrossRefPubMedGoogle Scholar
  39. 39.
    Conte FA, Orzel JA. Superior vena cava syndrome and bilateral subclavian vein thrombosis. CT and radionuclide venography correlation. Clin Nucl Med 1986;11:698–700.PubMedGoogle Scholar
  40. 40.
    Tello R, Scholz E, Finn JP, Costello P. Subclavian vein thrombosis detected with spiral CT and three-dimensional reconstruction. AJR Am J Roentgenol 1993;160:33–34.PubMedGoogle Scholar
  41. 41.
    Hartnell GG, Hughes LA, Finn JP, Longmaid HE 3rd. Magnetic resonance angiography of the central chest veins. A new gold standard? Chest 1995;107:1053–1057.PubMedGoogle Scholar
  42. 42.
    Sabeti S, Schillinger M, Mlekusch W, Haumer M, Ahmadi R, Minar E. Treatment of subclavian-axillary vein thrombosis: long-term outcome of anticoagulation versus systemic thrombolysis. Thromb Res 2002;108(5-6):279–285.CrossRefPubMedGoogle Scholar
  43. 43.
    Bernardi E, Piccioli A, Marchiori A, Girolami B, Prandoni P. Upper extremity deep vein thrombosis: Risk factors, diagnosis, and management. Semin Vasc Med 2001;1:105–110.CrossRefPubMedGoogle Scholar
  44. 44.
    Kommareddy A, Zaroukian MH, Hassouna HI. Upper extremity deep venous thrombosis. Seminars in Thrombosis & Hemostasis 2002;28:89–99.Google Scholar
  45. 45.
    Chang R, Horne MK, Mayo DJ, et al. Pulse-spray treatment of subclavian and jugular venous thrombi with recombinant tissue plasminogen activator. J Vasc Interv Radiol 1996;7:845–851.PubMedGoogle Scholar
  46. 46.
    Hicken GJ, Ameli M. Management of subclavian-axillary vein thrombosis: A review. Can J Surg 1998;41:13–25.PubMedGoogle Scholar
  47. 47.
    Joffe HV, Goldhaber SZ. Upper-extremity deep vein thrombosis. Circulation 106;2002:1874–1880.CrossRefPubMedGoogle Scholar
  48. 48.
    Wilkoff BL, Byrd CL, Love CJ, Hayes DL, Sellers TD, Schaerf R, Parsonnet V, Epstein LM, Sorrentino RA, Reiser C. Pacemaker lead extraction with the laser sheath: Results of the pacing lead extraction with the excimer sheath (PLEXES) trial. J Am Coll Cardiol 1999;33:1671–1676.CrossRefPubMedGoogle Scholar
  49. 49.
    Spittell PC, Vlietstra RE, Hayes DL, Higano ST. Venous obstruction due to permanent transvenous pacemaker electrodes: treatment with percutaneous transluminal balloon venoplasty. Pacing Clin Electrophysiol 1990;13:271–274.PubMedGoogle Scholar
  50. 50.
    Montgomery JH, D’Souza VJ, Dyer RB, Formanek AG, Prabhu SH. Nonsurgical treatment of the superior vena cava syndrome. Am J Cardiol 1985;56:829–830.CrossRefPubMedGoogle Scholar
  51. 51.
    Francis CM, Starkey IR, Errington ML, Gillespie IN. Venous stenting as treatment for pacemaker-induced superior vena cava syndrome. Am Heart J 1995;129:836–837.CrossRefPubMedGoogle Scholar
  52. 52.
    Mickley V, Gorich J, Rilinger N, Storck M, Abendroth D. Stenting of central venous stenoses in hemodialysis patients: long-term results. Kidney Int 1997;51(1):277–280.PubMedGoogle Scholar
  53. 53.
    Kalman PG, Lindsay TF, Clarke K, Sniderman KW, Vanderburgh L. Management of upper extremity central venous obstruction using interventional radiology. Ann Vasc Surg 1998;12(3):202–206CrossRefPubMedGoogle Scholar
  54. 54.
    Whitlow PL, Selmon M, O’Neill W, Knopf W, Uruchurtu E, Colombo A, Grube E, Londero H, Sousa JE, Simpson J. Treatment of uncrossable chronic total coronary occlusions with the frontrunner: Multicenter experience, ACC session Presentation Number: 811-3, ACC 2002.Google Scholar
  55. 55.
    Worley S, Gohn DC, Smith TL. Micro-dissection to open totally occluded subclavian veins. EP Lab Digest 2003;3:1–8.Google Scholar
  56. 56.
    de Cock CC, van Campen CM, Visser CA. Major dissection of the coronary sinus and its tributaries during lead implantation for biventricular stimulation. Angiographic follow-up. Europace 2004;6:43–47.CrossRefPubMedGoogle Scholar
  57. 57.
    Walker S, Levy T, Paul VE. Dissection of the Coronary Sinus Secondary to Pacemaker lead Manipulation. Pacing Clin Electrophysiol 2000;23:541–543.PubMedGoogle Scholar

Copyright information

© Springer Science + Business Media, Inc. 2005

Authors and Affiliations

  • Grzegorz Rozmus
    • 1
  • James P. Daubert
    • 1
  • David T. Huang
    • 1
  • Spencer Rosero
    • 1
  • Burr Hall
    • 1
  • Charles Francis
    • 2
  1. 1.Cardiology Unit of the Department of MedicineUniversity of Rochester Medical Center, Strong Memorial HospitalRochester
  2. 2.Hematology-Oncology Unit of the Department of MedicineUniversity of Rochester Medical Center, Strong Memorial HospitalRochester
  3. 3.Clinical Cardiac Electrophysiology, URMC Strong Memorial HospitalRochester

Personalised recommendations