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Upper extremity deep venous thrombosis and pulmonary embolism after transvenous lead replacement or upgrade procedures.
Pacing and Clinical Electrophysiology ( IF 1.7 ) Pub Date : 2020-05-08 , DOI: 10.1111/pace.13915 Caio Marcos de Moraes Albertini 1 , Katia Regina da Silva 2 , Marta Fernandes Lima 3 , Joaquim Maurício da Motta Leal Filho 4 , Martino Martinelli Filho 5 , Roberto Costa 2
Pacing and Clinical Electrophysiology ( IF 1.7 ) Pub Date : 2020-05-08 , DOI: 10.1111/pace.13915 Caio Marcos de Moraes Albertini 1 , Katia Regina da Silva 2 , Marta Fernandes Lima 3 , Joaquim Maurício da Motta Leal Filho 4 , Martino Martinelli Filho 5 , Roberto Costa 2
Affiliation
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.
中文翻译：
经静脉铅替代或升级程序后，上肢深静脉血栓形成和肺栓塞。
背景技术尽管很少报告相关的临床发现，但在有静脉导联的患者中经常发生静脉阻塞。更换铅或升级程序后，这些病变的发生率更高，但是仍然没有证据支持这种观察。目的探讨更换导线或升级导线后上肢深静脉血栓形成（UEDVT）和肺栓塞（PE）的发生率和可能的危险因素。方法于2013年4月至2016年7月进行前瞻性队列研究。术前评估包括静脉超声和肺血管造影。术后重复诊断检查以检测研究结果。多因素logistic回归模型用于确定预后因素。结果在84例患者中，有44例（52。4％为女性，平均年龄为59.3±15.2岁。铅故障（75.0％）是手术的主要指征。去除铅的病例为44（52.4％）。术后合并事件发生率为32.6％，其中UEDVT 24例（28.6％），PE 6例（7.1％）。10例（11.9％）患者发生了深静脉血栓形成的临床表现。UEDVT的独立预后因素是术前静脉造影中严重的侧支循环（优势比[OR] 4.7； 95％置信区间[CI] 1.1-19.8； P = .037）和经静脉铅提取（OR 27.4； 95％CI 5.8- 128.8； P <.0001）。结论涉及先前植入的静脉引线的再手术表现出较高的血栓栓塞并发症发生率。静脉吸铅对UEDVT的发展有重要影响。
更新日期：2020-05-08
中文翻译：
经静脉铅替代或升级程序后，上肢深静脉血栓形成和肺栓塞。
背景技术尽管很少报告相关的临床发现，但在有静脉导联的患者中经常发生静脉阻塞。更换铅或升级程序后，这些病变的发生率更高，但是仍然没有证据支持这种观察。目的探讨更换导线或升级导线后上肢深静脉血栓形成（UEDVT）和肺栓塞（PE）的发生率和可能的危险因素。方法于2013年4月至2016年7月进行前瞻性队列研究。术前评估包括静脉超声和肺血管造影。术后重复诊断检查以检测研究结果。多因素logistic回归模型用于确定预后因素。结果在84例患者中，有44例（52。4％为女性，平均年龄为59.3±15.2岁。铅故障（75.0％）是手术的主要指征。去除铅的病例为44（52.4％）。术后合并事件发生率为32.6％，其中UEDVT 24例（28.6％），PE 6例（7.1％）。10例（11.9％）患者发生了深静脉血栓形成的临床表现。UEDVT的独立预后因素是术前静脉造影中严重的侧支循环（优势比[OR] 4.7； 95％置信区间[CI] 1.1-19.8； P = .037）和经静脉铅提取（OR 27.4； 95％CI 5.8- 128.8； P <.0001）。结论涉及先前植入的静脉引线的再手术表现出较高的血栓栓塞并发症发生率。静脉吸铅对UEDVT的发展有重要影响。
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