open access

Vol 16, No 4 (2021)
Original paper
Published online: 2021-08-31
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Localized left brachiocephalic vein obstruction during the respiration cycle as a potential trigger of thrombotic complications of cardiac implantable electronic device and central venous catheter placement procedures

Roman Steckiewicz1, Przemysław Stolarz2, Michał Marchel3, Dariusz Konecki4
DOI: 10.5603/FC.2021.0035
·
Folia Cardiologica 2021;16(4):228-236.
Affiliations
  1. Department of Cardiology, Central University Hospital in Warsaw,, Banacha St. 1A, 02-097 Warsaw, Poland
  2. 1st Department of Cardiology, Medical University of Warsaw, Banacha St 1A, 02-097 Warsaw, Poland
  3. 1st Chair and Department of Cardiology, Medical University of Warsaw, Poland
  4. 2nd Departament of Radiology Medical University of Warsaw, Banacha St 1A, 02-097 Warsaw, Poland

open access

Vol 16, No 4 (2021)
Original Papers
Published online: 2021-08-31

Abstract

Introduction. The left brachiocephalic vein (LBCV) courses between the sternum and the aortic arch (or its main branches). Anomalous spatial positioning of the LBCV and these adjacent anatomical structures may result in LBCV compression. Such circumstances result in a narrowing or complete occlusion of this vein, which may affect the course of intravascular procedures, such as cardiac implantable electronic device (CIED) or central venous catheter (CVC) placement. This increases the risk of venous injury and/or the subsequent occlusion due to thrombus formation. Material and methods. Out of 2,112 de novo CIED implantation procedures performed in the period 2014–2019, 391 cases required intraoperative venography to identify the cause of difficulties in endovascular lead advancement. Venography data from these cases were analysed and only those cases were included for further analysis where the cause of difficulties was shown to be LBCV compression, further exacerbated on expiration. Results. Severe localized LBCV compression affecting the course of CIED implantation procedures was detected in 12 patients (8 women and 4 men, aged 80 ± 7 years). Such localized venous compression was observed mainly at the level where the brachiocephalic trunk and the left common carotid artery branch of the aortic arch. Conclusions. The analysed data showed the phenomenon of localized, respiration-related LBCV compression, which became exacerbated on expiration, in 3% of the analysed de novo CIED implantation procedures. This phenomenon may be associated with increased long-term thrombotic venous occlusion in the vascular segments containing cardiac leads or CVCs.

Abstract

Introduction. The left brachiocephalic vein (LBCV) courses between the sternum and the aortic arch (or its main branches). Anomalous spatial positioning of the LBCV and these adjacent anatomical structures may result in LBCV compression. Such circumstances result in a narrowing or complete occlusion of this vein, which may affect the course of intravascular procedures, such as cardiac implantable electronic device (CIED) or central venous catheter (CVC) placement. This increases the risk of venous injury and/or the subsequent occlusion due to thrombus formation. Material and methods. Out of 2,112 de novo CIED implantation procedures performed in the period 2014–2019, 391 cases required intraoperative venography to identify the cause of difficulties in endovascular lead advancement. Venography data from these cases were analysed and only those cases were included for further analysis where the cause of difficulties was shown to be LBCV compression, further exacerbated on expiration. Results. Severe localized LBCV compression affecting the course of CIED implantation procedures was detected in 12 patients (8 women and 4 men, aged 80 ± 7 years). Such localized venous compression was observed mainly at the level where the brachiocephalic trunk and the left common carotid artery branch of the aortic arch. Conclusions. The analysed data showed the phenomenon of localized, respiration-related LBCV compression, which became exacerbated on expiration, in 3% of the analysed de novo CIED implantation procedures. This phenomenon may be associated with increased long-term thrombotic venous occlusion in the vascular segments containing cardiac leads or CVCs.
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Keywords

left brachiocephalic vein, venography, venous compression, occlusion, stenosis, CIED, CVC

About this article
Title

Localized left brachiocephalic vein obstruction during the respiration cycle as a potential trigger of thrombotic complications of cardiac implantable electronic device and central venous catheter placement procedures

Journal

Folia Cardiologica

Issue

Vol 16, No 4 (2021)

Article type

Original paper

Pages

228-236

Published online

2021-08-31

DOI

10.5603/FC.2021.0035

Bibliographic record

Folia Cardiologica 2021;16(4):228-236.

Keywords

left brachiocephalic vein
venography
venous compression
occlusion
stenosis
CIED
CVC

Authors

Roman Steckiewicz
Przemysław Stolarz
Michał Marchel
Dariusz Konecki

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