■引线依赖性静脉闭塞可能会阻碍中央静脉接入装置(CVAD)的插入。这次回顾的目的,队列研究旨在评估使用心脏可植入电子设备(CIED)的患者植入CVAD的机会.
■我们回顾并分析了2008年6月至2021年7月期间接受经静脉导线拔除(TLE)的CIED患者的3,075例静脉造影。评估了静脉通畅性与CVAD放置机会之间的关系。
■在2,318名(75.38%)患者中,静脉造影显示同侧静脉端口植入没有潜在障碍。在左侧有导线的患者中,显著狭窄更常影响锁骨下静脉,而不是头臂静脉[1,595(55.29%)830(28.63%),分别]或上腔静脉(SVC)[21(0.73%)例]。此外,对侧锁骨下静脉和头臂静脉也变窄[35(2.35%)和27(1.24%),分别]。在2,318例(75.38%)和2,291例(97.91%)患者中,在CIED侧或相对侧评估了端口插入的机会。分别),246名(8.00%)和22名(0.94%)患者的插入困难/表现可疑,511名(16.62%)/27名(1.15%)患者的插入困难/表现可疑。
■(I)不同程度的导线依赖性静脉阻塞(LDVO)是CIED患者常见的发现;(II)胸部对侧的主要胸静脉也可能明显变窄;(III)在导线停留时间较长的患者或CIED切除后的患者尝试插入CVAD前应考虑静脉造影,包括计划的对侧端口放置。
UNASSIGNED: Lead-dependent venous occlusion may impede the insertion of a central venous access device (CVAD). The aim of this retrospective, cohort study was to assess the chance of implantation of CVAD in patients with cardiac implantable electronic devices (CIEDs).
UNASSIGNED: We reviewed and analyzed 3,075 venograms of patients with CIEDs undergoing transvenous lead extraction (TLE) between June 2008 and July 2021. Relationship between venous patency and the chance of CVAD placement was estimated.
UNASSIGNED: In 2,318 (75.38%) patients,
venography showed no potential obstacles to venous port implantation on the ipsilateral side. In patients with leads on the left side, significant narrowing more often affected the subclavian vein than the brachiocephalic vein [1,595 (55.29%) vs. 830 (28.63%), respectively] or the superior vena cava (SVC) [21 (0.73%) cases]. Furthermore, the subclavian and brachiocephalic veins on the opposite side were also narrowed [35 (2.35%) and 27 (1.24%), respectively]. The chances of port insertion were assessed as easy on CIED side or opposite side in 2,318 (75.38%) and 2,291 (97.91%) patients, respectively), as difficult insertion/questionable performance in 246 (8.00%) and 22 (0.94% patients) and doubtful or impossible insertion/questionable performance in 511 (16.62%)/27 (1.15%) patients with CIED.
UNASSIGNED: (I) Varying degrees of lead-dependent venous obstruction (LDVO) is a frequent finding in patients with CIEDs; (II) the major thoracic veins on the opposite side of the chest may also be significantly narrowed; (III)
venography should be considered before attempted CVAD insertion in patients with long lead dwell times or in patients after CIED removal, including planned contralateral port placement.