Background
Patients undergoing pacemaker and/or cardioverter–defibrillator (PM/ICD) implantation/upgrade might have difficult access due to sub/total central vein occlusions, usually related to prior venous manipulation. This study aimed to describe the feasibility and safety of the endovascular approach to recanalize central veins to allow PM/ICD implantation.
Methods
From January 2007 to December 2008, a series of 29 patients who underwent central vein recanalization prior to PM/ICD implantation were included in this analysis. Femoral vein was the primary access, and brachial/cephalic vein were used when recanalization was not possible via femoral access. Venoplasty was primarily attempted by wiring the stenosis, and total occlusion devices were used when wiring approach failed.
Methods
From January 2007 to December 2008, a series of 29 patients who underwent central vein recanalization prior to PM/ICD implantation were included in this analysis. Femoral vein was the primary access, and brachial/cephalic vein were used when recanalization was not possible via femoral access. Venoplasty was primarily attempted by wiring the stenosis, and total occlusion devices were used when wiring approach failed.
Results
The mean age was 71.9 years, with a high rate of comorbidities including congestive heart failure (65.5%), chronic renal failure (44.8%), chronic hemodialysis (31.0%), diabetes (27.6%), and peripheral vascular disease (20.7%). Angiographic and procedural characteristics are described in Table 1 . All patients had a history of prior venous access. Successful vein recanalization followed by successful PM/ICD implantation/upgrade was achieved in 26 patients (89.7%) without peri-procedural complications. Recanalization failed in two patients and one case re-occluded after the venoplasty. One patient died during the hospitalization due to severe respiratory failure not related to the procedure.
