Vasoconstrictive responses of the cephalic vein during first-time cardiac implantable electronic device placement
Abstract
Background: During cardiac implantable electronic device (CIED) implantation procedures cardiac leads have been mostly introduced transvenously. The associated injury to the selected vessel and adjacent tissues may induce reflex vasoconstriction. The aim of the study was to assess the incidence of cephalic vein (CV) vasoconstriction during first-time CIED implantation.
Materials and methods: Of the 146 evaluated first-time CIED implantation procedures conducted in our centre in 2016, we selected those during which CV vasoconstriction was recorded. We focused on the stage of the procedure involving CV cutdown and/or axillary vein (AV)/subclavian vein (SV) puncture for lead insertion. Only cases documented via venography were considered.
Results: Vasoconstriction was observed in 11 patients (5 females and 6 males, mean age 59.0 ± 21.2 years). The presence of this phenomenon affected the stage of CIED implantation involving cardiac lead insertion to the venous system, in severe cases, requiring a change of approach from CV cutdown to AV/SV puncture. The extent of vasoconstriction front propagation was limited to the nearest valves. Histological examinations of collected CV samples revealed an altered spatial arrangement of myocytes in the tunica media at the level of leaflet attachment.
Conclusions: Cephalic vein vasoconstriction is a rare phenomenon associated with accessing the venous system during first-time CIED implantation. The propagation of CV constriction was limited by the location of the nearest valves.
Keywords: cephalic veinvenous spasmtunica mediavenotomypuncturelead implantationcardiac implantable electronic device
References
- Bongiorni MG, Proclemer A, Dobreanu D, et al. Preferred tools and techniques for implantation of cardiac electronic devices in Europe: results of the European Heart Rhythm Association survey. Europace. 2013; 15(11): 1664–1668.
- Cooper RM, Krishnan U, Pyatt JR. Central venous spasm during pacemaker insertion. Heart. 2010; 96(18): 1484.
- Duan Xu, Ling F, Shen Y, et al. Venous spasm during contrast-guided axillary vein puncture for pacemaker or defibrillator lead implantation. Europace. 2012; 14(7): 1008–1011.
- Jacobs DM, Fink AS, Miller RP, et al. Anatomical and morphological evaluation of pacemaker lead compression. Pacing Clin Electrophysiol. 1993; 16(3 Pt 1): 434–444.
- Kodani T, Mine T, Kishima H, et al. Spontaneous subclavian venous occlusion before electronic device implantation. Asian Cardiovasc Thorac Ann. 2015; 23(5): 530–534.
- Kolettis TM, Lysitsas DN, Apostolidis D, et al. Improved 'cut-down' technique for transvenous pacemaker lead implantation. Europace. 2010; 12(9): 1282–1285.
- Loukas M, Myers CS, Wartmann ChT, et al. The clinical anatomy of the cephalic vein in the deltopectoral triangle. Folia Morphol. 2008; 67(1): 72–77.
- Neri R, Cesario AS, Baragli D, et al. Permanent pacing lead insertion through the cephalic vein using an hydrophilic guidewire. Pacing Clin Electrophysiol. 2003; 26(12): 2313–2314.
- Newton DJ, McLeod GA, Khan F, et al. Mechanisms influencing the vasoactive effects of lidocaine in human skin. Anaesthesia. 2007; 62(2): 146–150.
- Oginosawa Y, Abe H, Nakashima Y. Prevalence of venous anatomic variants and occlusion among patients undergoing implantation of transvenous leads. Pacing Clin Electrophysiol. 2005; 28(5): 425–428.
- Steckiewicz R, Górko D, Świętoń EB, et al. Axillary vein spasm during cardiac implantable electronic device implantation. Folia Morphol. 2016; 75(4): 543–549.
- Tse HF, Lau CP, Leung SK. A cephalic vein cutdown and venography technique to facilitate pacemaker and defibrillator lead implantation. Pacing Clin Electrophysiol. 2001; 24(4 Pt 1): 469–473.
- Wali MA, Eid RA, Dewan M, et al. Pre-existing histopathological changes in the cephalic vein of renal failure patients before arterio-venous fistula (AVF) construction. Ann Thorac Cardiovasc Surg. 2006; 12(5): 341–348.
