The effect of innominate vein occlusion on the selection of cardiac pacing device implantation technique

Abstract

Successful transvenous insertion of cardiac pacing leads during pacemaker implantation is contingent on the patency of consecutive vessels. Vessel obstruction can be detected during either first-time or subsequent procedures associated with the need to introduce additional pacing leads. Venous thrombosis is the most common cause for vessel occlusion, and the main occlusion site along the venous route used for cardiac lead insertion is the subclavian vein, in contrast to the innominate vein or the superior vena cava, whose occlusion rates are much lower. The patient presented here developed venous thrombosis in the left brachiocephalic vein (BCV) also known as the innominate vein 5 years after a first-time permanent cardiac pacing system implantation. Contrast-enhanced vascular imaging conducted during a subsequent procedure intended to introduce a new lead revealed the location and extent of BCV occlusion. Out of 2,258 procedures requiring cardiac lead insertion and performed within a 5-year period (2010–2014) at the Clinic (including 68 cases of adding a lead to the existing device) this was the only case of BCV occlusion of this aetiology. Literature reports on BCV emphasize the uncommonness of this type of occlusion and discuss its effect on the course of the procedure.