Venous System Interventions for Device Implantation - 28/02/18

Doi : 10.1016/j.ccep.2017.11.017

Jose M. Marcial, MD, Seth J. Worley, MD, FHRS ^⁎
Department of Medicine, Division of Cardiology, Cardiac Arrhythmia Center, Medstar Heart and Vascular Institute, Medstar Washington Hospital Center, 110 Irving Street Northwest, Washington, DC 20010, USA

^∗Corresponding author. Department of Medicine, Division of Cardiology, Cardiac Arrhythmia Center, Medstar Heart and Vascular Institute, Medstar Washington Hospital Center, 110 Irving Street Northwest, Suite 5A-12, Washington, DC 20010.Department of MedicineDivision of CardiologyCardiac Arrhythmia CenterMedstar Heart and Vascular InstituteMedstar Washington Hospital Center110 Irving Street NorthwestSuite 5A-12WashingtonDC20010

Résumé

Subclavian obstruction is common after lead implantation and the need to add or replace a lead is increasing. Subclavian venoplasty (SV) is a safe and effective option for venous occlusion. Peripheral venography overestimates the severity of the obstruction. A wire can usually be advanced into the central circulation for SV. Compared with dilators, SV improves the quality of venous access, providing unrestricted catheter manipulation for His bundle pacing and left ventricular lead implantation. SV preserves venous access and reduces lead burden. SV can easily be added to the implanting physicians lead management options.

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Keywords : Subclavian occlusion, Venoplasty, Upgrade, Biventricular, Occlusion, Stenosis, His pacing, Focused force venoplasty

Plan

Key points

Introduction

Epidemiology

Pathophysiology of subclavian occlusions

Safety and efficacy of subclavian venoplasty

Step-by-Step Approach to Subclavian Venoplasty

Balloon options

Focused force venoplasty

Factors that make a subclavian occlusion difficult to cross

Combining retained wire lead removal and venoplasty

Subclavian venoplasty: quality of venous access, lead burden, and preservation of venous access

Conflict of Interest: None (J.M. Marcial). Royalties from Merit Medical and Pressure Products for the sale of the Worley LV lead implant tools. Compensation from Medtronic, Abbott, and Biotronik for teaching the “Interventional Approach to LV lead Implantation” using the Worley tools and techniques. Neither Merit Medical nor Pressure products sell a balloon for venoplasty. The author does not receive direct or indirect compensation from Merit Medical for the sale of the accessories (catheters, wires, and contrast injection system) discussed in this article. The author has no overt or covert financial interest in promoting the use of subclavian venoplasty to obtain and/or improve venous access (S.J. Worley).