Utility and Safety of Axillo-subclavian Venous Imaging with Carbon Dioxide (CO2) Prior to Chronic Lead System Revisions
| Autor: | Sean K. Calhoun, Robert F. Coyne, Jeanne R. Schwartz, Jonathan S. Sussman, Stephen L. Winters, Jay H. Curwin, Karen Quinlan, Thaddeus M. Yablonsky |
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| Rok vydání: | 2010 |
| Předmět: |
medicine.medical_specialty
medicine.diagnostic_test business.industry medicine.medical_treatment Antecubital Fossa Venography Mediastinum Interventional radiology General Medicine Implantable cardioverter-defibrillator Surgery medicine.anatomical_structure Iodinated contrast medicine Cardiology and Cardiovascular Medicine business Vein Axillary vein |
| Zdroj: | Pacing and Clinical Electrophysiology. 33:790-794 |
| ISSN: | 0147-8389 |
| DOI: | 10.1111/j.1540-8159.2009.02680.x |
| Popis: | Background: Prior to attempting placement of one or more electrodes to revise existing rhythm control devices, patency of the central veins should be documented, in view of a high incidence of significant chronic occlusions. Since iodinated contrast venography may be contraindicated in select situations, imaging of the axillo-subclavian venous system with gaseous carbon dioxide (CO2) was evaluated prospectively in 23 consecutive individuals who were considered for revision of previously implanted pacemaker or automatic cardioverter defibrillator lead systems. Methods: Approximately 20 mL of CO2 were manually infused via CO2 primed injection tubing into a vein at or above the level of the antecubital fossa ipsilateral to the side of prior lead placements. Digital subtraction imaging over the axillo-subclavian region, lower neck, and mediastinum was performed. Formal interpretation was obtained from one of three interventional radiologists and at least one electrophysiologist. Results: Significant venous occlusions were identified in five (22%) patients. Vascular access utilized for the subsequent 18 revisions performed included the imaged patent ipsilateral vein in 14 patients and the contralateral, right-sided subclavian venous system in three patients. One patient required epicardial left ventricular lead placement. There were no complications from venography. Conclusions: Axillo-subclavian venography with gaseous CO2 in patients undergoing pacemaker or implantable cardioverter defibrillator lead revisions is feasible and safe when use of iodinated dye is contraindicated. This technique should be employed in patients with azotemia, dye contrast allergies, or significant inflammation in the vicinity of the intravenous line insertion. (PACE 2010; 790–794) |
| Databáze: | OpenAIRE |
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