title: Subclavian venoplasty by the implanting physicians in 373 patients over 11 years.
abstract: BACKGROUND
  The need to add a lead(s) despite subclavian/innominate obstruction is increasing. Subclavian venoplasty may be a good alternative to the commonly employed options; however, there are few reports in the literature, and all are by interventional radiologists.
  
  
  OBJECTIVE
  To describe the procedural details, results and safety of venoplasty by implanting physicians in a large group of consecutive patients.
  
  
  METHODS
  Safety, lead function and success were established from review of the procedure reports and clinical complications in 373 consecutive venoplasty patients from 1999-2010. Procedural details were obtained by review of the angiograms (venograms) and procedural flow charts of 152 consecutive patients from 2004-2007.
  
  
  RESULTS
  Venoplasty was successful in 371 of 373 patients without damage to the existing leads and without clinical complications. Total angiographic occlusion was demonstrated in 65% of cases by peripheral venogram, but in only 20% of cases by contrast injection at the site of obstruction; 86% were crossed with a hydrophilic wire. Microdissection and excimer laser were used to cross three of the four wire-refractory occlusions. Obstruction was both central and peripheral in 22.1% of cases and central only in 17%. The time required to cross the obstruction and perform venoplasty was 13 ± 21 minutes. A noncompliant balloon was successful in most, but an ultranoncompliant balloon was required in 13% of cases. Contrast extravasation was common during crossing of a total obstruction and also was observed with balloon rupture on three occasions, but was not clinically significant.
  
  
  CONCLUSIONS
  Subclavian venoplasty is a safe, practical lead-management option that can be used by implanting physicians.
authors.affiliation: Implant Program, Heart Center, Lancaster General Hospital, Lancaster, Pennsylvania, USA. seth@mcworley.com
authors.forename: Seth Joseph
authors.initials: SJ
authors.lastname: Worley
authors.forename: Douglas Charles
authors.initials: DC
authors.lastname: Gohn
authors.forename: Robert Ward
authors.initials: RW
authors.lastname: Pulliam
authors.forename: Mandy A
authors.initials: MA
authors.lastname: Raifsnider
authors.forename: Benjamin I
authors.initials: BI
authors.lastname: Ebersole
authors.forename: Joann
authors.initials: J
authors.lastname: Tuzi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002404:Catheterization / Q000379:methods*; D004567:Electrodes, Implanted / Q000009:adverse effects*; D004868:Equipment Failure; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010690:Phlebography; D012189:Retrospective Studies; D013350:Subclavian Vein / Q000000981:diagnostic imaging / Q000601:surgery*; D013997:Time Factors; D020246:Venous Thrombosis / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*