Skip to main content

Advertisement

SpringerLink
Log in

Venous Thrombosis and Stenosis After Implantation of Pacemakers and Defibrillators

  • Review
  • Published:
Journal of Interventional Cardiac Electrophysiology Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
$34.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or eBook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  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.

    CAS  PubMed  Google Scholar 

  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.

    CAS  Google Scholar 

  3. American Heart Association. Heart Disease and Stroke Statistisc–2004 Update. Dallas, Tex.: American Heart Association, 2003.

  4. Higgins SL. automatic implantable cardiac defibrillators. Curr Treat Options Cardiovasc Med 2002;4:287–293.

    PubMed  Google Scholar 

  5. Meisner R. World Wide Medtronic marketing estimates from historical industry implants, patient mortality, and device registry database. Personal communication, August 30, 2004.

  6. Spittell PC, Hayes DL. Venous complications after insertion of a transvenous pacemaker. Mayo Clin Proc 1992;67:258–265.

    CAS  PubMed  Google Scholar 

  7. Hill SL, Berry RE. Subclavian vein thrombosis: A continuing challenge. Surgery 1990;108:1–9.

    CAS  PubMed  Google Scholar 

  8. Demeter SL, Pritchard JS, Piedad OH, et al. Upper extremity thrombosis: Etiology and prognosis. Angiology 1982;33:743–755.

    CAS  PubMed  Google Scholar 

  9. Tilney NL, Griffiths HJG, Edwards EA. Natural history of major venous thrombosis of the upper extremity. Arch Surg 1970;101:792–796.

    CAS  PubMed  Google Scholar 

  10. Sethi GK, Bhayana JN, Scott SM. Innominate venous thrombosis: A rare complication of transvenous pacemaker electrodes. Am Heart J 1974;87:770–772.

    Article  CAS  PubMed  Google Scholar 

  11. Blackburn T, Dunn M. Pacemaker-induced superior vena cava syndrome: Consideration of management. Am Heart J 1988;116:893–896.

    Article  CAS  PubMed  Google Scholar 

  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.

    CAS  PubMed  Google Scholar 

  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.

    PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    CAS  PubMed  Google Scholar 

  18. Goto Y, Abe T, Sekine S, Sakurada T. Long-term thrombosis after transvenous permanent pacemaker implantation. Pacing Clin Electrophysiol 1998;21:1192–1195.

    CAS  PubMed  Google Scholar 

  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.

    CAS  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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. 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.

    Article  CAS  PubMed  Google Scholar 

  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.

    CAS  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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. 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. 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.

    Article  CAS  PubMed  Google Scholar 

  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.

    CAS  PubMed  Google Scholar 

  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.

    CAS  PubMed  Google Scholar 

  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.

    CAS  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    PubMed  Google Scholar 

  37. Bettmann MA Noninvasive and venographic diagnosis of deep vein thrombosis. Cardiovasc Intervent Radiol 1988;11 (Suppl) S15–20.

    PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    CAS  PubMed  Google Scholar 

  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.

    CAS  PubMed  Google Scholar 

  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.

    CAS  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  44. Kommareddy A, Zaroukian MH, Hassouna HI. Upper extremity deep venous thrombosis. Seminars in Thrombosis & Hemostasis 2002;28:89–99.

    Google Scholar 

  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.

    CAS  PubMed  Google Scholar 

  46. Hicken GJ, Ameli M. Management of subclavian-axillary vein thrombosis: A review. Can J Surg 1998;41:13–25.

    CAS  PubMed  Google Scholar 

  47. Joffe HV, Goldhaber SZ. Upper-extremity deep vein thrombosis. Circulation 106;2002:1874–1880.

    Article  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    CAS  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    CAS  PubMed  Google Scholar 

  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):202–206

    Article  CAS  PubMed  Google Scholar 

  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.

  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. 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.

    Article  CAS  PubMed  Google Scholar 

  57. Walker S, Levy T, Paul VE. Dissection of the Coronary Sinus Secondary to Pacemaker lead Manipulation. Pacing Clin Electrophysiol 2000;23:541–543.

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Cardiology Unit of the Department of Medicine, University of Rochester Medical Center, Strong Memorial Hospital, 601 Elmwood Ave., Box 679, Rochester, NY, 14642

    Grzegorz Rozmus MD, James P. Daubert, David T. Huang, Spencer Rosero & Burr Hall

  2. Hematology-Oncology Unit of the Department of Medicine, University of Rochester Medical Center, Strong Memorial Hospital, 601 Elmwood Ave., Box 679, Rochester, NY, 14642

    Charles Francis

Authors
  1. Grzegorz Rozmus MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. James P. Daubert
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. David T. Huang
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Spencer Rosero
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Burr Hall
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Charles Francis
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Grzegorz Rozmus MD.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Rozmus, G., Daubert, J.P., Huang, D.T. et al. Venous Thrombosis and Stenosis After Implantation of Pacemakers and Defibrillators. J Interv Card Electrophysiol 13, 9–19 (2005). https://doi.org/10.1007/s10840-005-1140-1

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10840-005-1140-1

Search

Navigation