Utility and safety of axillo-subclavian venous imaging with carbon dioxide (CO 2) prior to chronic lead system revisions

Stephen Winters, Jay H. Curwin, Jonathan S. Sussman, Robert Coyne, Sean K. Calhoun, Thaddeus M. Yablonsky, Jeanne R. Schwartz, Karen Quinlan

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

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 (CO 2) 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 CO 2 were manually infused via CO 2 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 CO 2 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.

Original languageEnglish (US)
Pages (from-to)790-794
Number of pages5
JournalPACE - Pacing and Clinical Electrophysiology
Volume33
Issue number7
DOIs
StatePublished - Jul 1 2010
Externally publishedYes

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Carbon Monoxide
Carbon Dioxide
Phlebography
Safety
Veins
Coloring Agents
Azotemia
Defibrillators
Implantable Defibrillators
Mediastinum
Patient Rights
Blood Vessels
Hypersensitivity
Electrodes
Neck
Lead
Inflammation
Equipment and Supplies
Injections
Incidence

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Winters, Stephen ; Curwin, Jay H. ; Sussman, Jonathan S. ; Coyne, Robert ; Calhoun, Sean K. ; Yablonsky, Thaddeus M. ; Schwartz, Jeanne R. ; Quinlan, Karen. / Utility and safety of axillo-subclavian venous imaging with carbon dioxide (CO 2) prior to chronic lead system revisions. In: PACE - Pacing and Clinical Electrophysiology. 2010 ; Vol. 33, No. 7. pp. 790-794.
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abstract = "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 (CO 2) 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 CO 2 were manually infused via CO 2 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 CO 2 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.",
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Utility and safety of axillo-subclavian venous imaging with carbon dioxide (CO 2) prior to chronic lead system revisions. / Winters, Stephen; Curwin, Jay H.; Sussman, Jonathan S.; Coyne, Robert; Calhoun, Sean K.; Yablonsky, Thaddeus M.; Schwartz, Jeanne R.; Quinlan, Karen.

In: PACE - Pacing and Clinical Electrophysiology, Vol. 33, No. 7, 01.07.2010, p. 790-794.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Utility and safety of axillo-subclavian venous imaging with carbon dioxide (CO 2) prior to chronic lead system revisions

AU - Winters, Stephen

AU - Curwin, Jay H.

AU - Sussman, Jonathan S.

AU - Coyne, Robert

AU - Calhoun, Sean K.

AU - Yablonsky, Thaddeus M.

AU - Schwartz, Jeanne R.

AU - Quinlan, Karen

PY - 2010/7/1

Y1 - 2010/7/1

N2 - 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 (CO 2) 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 CO 2 were manually infused via CO 2 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 CO 2 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.

AB - 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 (CO 2) 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 CO 2 were manually infused via CO 2 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 CO 2 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.

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