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Vol 12, No 2 (2006)
Research paper
Published online: 2006-04-27

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Ultrasound evaluation of vascular thrombotic complications following endovascular implantation of cardiac pacemaker electrodes

Robert Juszkat, Fryderyk Pukacki, Maciej Zieliński, Grzegorz Oszkinis, Marcin Gabriel, Anna Kubicka, Anna Miśkiewicz, Piotr Bręborowicz, Wacław Majewski
Acta Angiologica 2006;12(2):69-79.

Abstract

Background. A rapid increase of percutaneous endovascular implantation of cardiac electrostimulation systems multiplies the risk of the most common post-surgery complication in the form of vascular thrombosis and its most dangerous consequence - pulmonary embolism. Gradual, clinically silent increase of thrombotic lesions in veins subjected to manipulation indicates the need for close monitoring based on possibly precise laboratory analyses. Also in those cases, validity of routine pharmacological antithrombotic preventive therapy should be considered. The objective of this paper was to evaluate the utility of B-mode ultrasound protocol with colour Doppler imaging in diagnostics of thrombotic lesions in veins of upper extremities following implantation of electrodes.
Material and methods. 106 patients were examined following endovascular implantation of cardiac electrostimulation systems at the department of cardiology of the Research Hospital No. 1 of the Medical University in Poznań due to arrhythmia. Post-procedure period ranged from 3 weeks to 12 years (150 weeks on average). Protocol of the study included medical history, clinical examination and ultrasound imaging (B-mode protocol combined with colour Doppler imaging). To verify ultrasound results DSA phlebography and chest X-ray were performed.
Results. Ultrasound imaging revealed thrombotic lesions in veins of upper extremities in 6/105 (5.7%) of the patients. 2 of them showed mainly post-exercise symptoms. DSA phlebography confirmed all diagnoses, and combined with chest X-ray imaging it revealed a relationship between thrombosis and electrostimulation electrodes. The age of patients suffering from thrombosis was higher than in the case of other patients and amounted to 73.5 vs. 45.6 years respectively. Concomitant diabetes and hypertension were observed in 60/106 and thrombosis in 3/60 patients. Oral anticoagulants were administered to 15/106 subjects, 2/15 of which were diagnosed with thrombotic lesions.
Conclusions. Risk of thromboembolic complications following percutaneous endovascular implantation of cardiac electrostimulation systems indicates the need for continuous monitoring of patients. Ultrasound imaging (B-mode combined with colour Doppler imaging) meets monitoring requirements. In elderly patients, the introduction of 2-week preventive antithrombotic therapy with low molecular weight heparin (LMWH) after the procedure seems to be justified.

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