Upper extremity deep venous thrombosis and pulmonary embolism after transvenous lead replacement or upgrade procedures

Caio Marcos de Moraes Albertini; Katia Regina da Silva; Marta Fernandes Lima; Joaquim Maurício Da Motta Leal Filho; Martino Martinelli Filho; Roberto Costa

doi:10.1111/pace.13915

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Upper extremity deep venous thrombosis and pulmonary embolism after transvenous lead replacement or upgrade procedures

Journal article

Peer reviewed

Upper extremity deep venous thrombosis and pulmonary embolism after transvenous lead replacement or upgrade procedures

Caio Marcos de Moraes Albertini, Katia Regina da Silva, Marta Fernandes Lima, Joaquim Maurício Da Motta Leal Filho, Martino Martinelli Filho and Roberto Costa

Pacing and clinical electrophysiology, Vol.43(5), pp.495-502

05/2020

DOI: 10.1111/pace.13915

PMID: 32277706

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Abstract

Background Venous obstructions are frequent in patients with transvenous leads, although related clinical findings are rarely reported. After lead replacement or upgrade procedures, these lesions are even more frequent, but there is still no evidence to support this observation. Aim To investigate the incidence and possible risk factors for upper extremity deep venous thrombosis (UEDVT) and pulmonary embolism (PE) after lead replacement or upgrade procedures. Methods Prospective cohort carried out between April 2013 and July 2016. Preoperative evaluation included venous ultrasound and pulmonary angiotomography. Diagnostic exams were repeated postoperatively to detect the study outcomes. Multivariate logistic regression models were used to identify prognostic factors. Results Among the 84 patients included, 44 (52.4%) were female and mean age was 59.3 ± 15.2 years. Lead malfunctioning (75.0%) was the main surgical procedure indication. Lead removal was performed in 44 (52.4%) cases. The rate of postoperative combined events was 32.6%, with 24 (28.6%) cases of UEDVT and six (7.1%) cases of PE. Clinical manifestations of deep venous thrombosis occurred in 10 (11.9%) patients. Independent prognostic factors for UEDVT were severe collateral circulation in the preoperative venography (odds ratio [OR] 4.7; 95% confidence interval [CI] 1.1–19.8; P = .037) and transvenous lead extraction (OR 27.4; 95% CI 5.8–128.8; P < .0001). Conclusion Reoperations involving previously implanted transvenous leads present high rates of thromboembolic complications. Transvenous lead extraction had a significant impact on the development of UEDVT. These results show the need of further studies to evaluate the role of preventive strategies for this subgroup of patients.

Ultrasonography

artificial

cardiac pacing

color

Doppler

phlebography

pulmonary embolism

transvenous lead extraction

venous thrombosis

Details

Title: Subtitle: Upper extremity deep venous thrombosis and pulmonary embolism after transvenous lead replacement or upgrade procedures
Creators: Caio Marcos de Moraes Albertini - Universidade de São Paulo
Katia Regina da Silva - Universidade de São Paulo
Marta Fernandes Lima - Universidade de São Paulo
Joaquim Maurício Da Motta Leal Filho - Universidade de São Paulo
Martino Martinelli Filho - Universidade de São Paulo
Roberto Costa - Universidade de São Paulo
Resource Type: Journal article
Publication Details: Pacing and clinical electrophysiology, Vol.43(5), pp.495-502
DOI: 10.1111/pace.13915
PMID: 32277706
NLM abbreviation: Pacing Clin Electrophysiol
ISSN: 0147-8389
eISSN: 1540-8159
Number of pages: 8
Grant note: Fundação de Amparo à Pesquisa do Estado de São Paulo (2013/180237)
Language: English
Date published: 05/2020
Academic Unit: Radiology
Record Identifier: 9985180929902771

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