Progression of venous pathology after pacemaker and cardioverter-defibrillator implantation: A prospective serial venographic study

Figures & data

Table I.  Acute and subacute complications after pacemaker or implantable cardioverter-defibrillator implantation in 150 patients.

Hemorrhagic and technical complications	n (%)
Dislocated atrial lead (1–20 days postimplant)	3 (2.0%)
Lead damage (subclavian crush, 3 months)	1 (0.7%)
Impending skin perforation by lead (3 months)	1 (0.7%)
Pericardial effusion (1–3 days)	2 (1.3%)
Pneumothorax (1 day)	1 (0.7%)
Major hematoma	5 (3.3%)
Wound revision required	1 (0.7%)
Pacemaker infection	0
Venous and thromboembolic complications at 6 months
Venous stenosis	14 (10.3%)^a
Complete venous occlusion	5 (3.7%)^a
Venographic lead-associated thrombi	20 (14.3%)^b
Acute symptomatic UEDVT	1 (0.7%)
Symptomatic pulmonary embolism	5 (3.3%)

^a 136 patients with both base-line and 6-month venography successful.

^b 140 patients with 6-month venography successful.

Table

ICD	implantable cardioverter-defibrillator
ICV	intravenous contrast venography
PE	pulmonary embolism
PM	pacemaker
TVO	total venous occlusion

Figure 1.  Venographic images prior to implantation of a dual chamber pacemaker (A), and 6 months (B) and 25 months (C) postoperatively on a 57-year-old male patient. A stenosis (arrow) of the subclavian vein was seen in the 6-month study (B), and complete occlusion of the same vessel with collateral venous flow after 2 years (C).

Figure 2.  Panels A and B depict a filling defect suggestive of thrombus formation (arrows) in the 6-month venography of an 81-year-old male patient implanted with a biventricular pacemaker. Late venography (C) 29 months after implantation shows complete occlusion of the axillary vein (arrow) and several new collateral vessels.

Table II.  Venographic findings in 50 patients at base-line, 6 months, and at 2 years.

Base-line venography		6 month venography		2-year venography
Finding	n (%)	Finding	n (%)	Finding			n (%)	New lesion (n)
Abnormal	2 (4%) ⇒	Abnormal	2 (4%) ⇒	Abnormal			2 (4%)
Stenosis	1 (2%) ⇒	No change in base-line lesions		No change in base-line lesions				0
Borderline stenosis	1 (2%) ⇒
Normal	48 (96%) ⇒	Normal	25 (50%) ⇒	Normal			23 (46%)	0
				Abnormal			2 (4%)
				New TVO			1
				Borderline stenosis			1
		Abnormal	23 (46%) ⇒	No progression/resolution			18 (36%)	0
		Stenosis	7 (14%) ⇒	Lesion progression			3 (6%)
		TVO	3 (6%)	Stenosis to TVO			2	2
		Thrombus	13 (26%)	Thrombus to TVO			1	1
				Lesion resolution			2 (4%)
			⇒	Resolution of thrombus			2	0
				Total			50	5 (10%)
Base-line		6 months	Δ from base-line	2 years	Δ from base-line	P	Δ from 6 months	P
Dmin	10.9±3.1	9.2±3.2	−15.6%	8.9±2.9	−18.3%	0.005	−3.2%	0.536
Dmax	17.9±4.2	16.2±4.0	−9.5%	16.9±4.1	−5.6%	0.356	+4.3%	0.261

Δ=change; D_max=maximum diameter; D_min=minimum diameter; TVO=total venous occlusion.