title: Vascular interventions in young patients undergoing transvenous pacemaker revision.
abstract: OBJECTIVE
  Transvenous lead implantation for pacemaker (PM) or implantable cardioverter defibrillators systems in children and young patients with congenital heart disease is widely practiced. With longer implantation times, the risk for vascular occlusion increases. Transvenous angioplasty may be used to maintain venous patency for system revision in the future. Retrospective analysis of the interventional techniques employed in our young patients undergoing PM revision may identify its clinical benefit.
  
  
  RESULTS
  Between May 2005 and August 2010, 28 procedures to maintain central venous patency were performed in 24 patients. Median age was 14.3 years (range, 3.6-29.5 years). The median lead age at time of intervention was 6.8 years (range, 8 days-21.5 years). Balloon dilation of the stenotic vessels was performed with and without prior lead removal. Revascularization with stent implantation was successfully attempted in all clinically relevant obstructions. All PM systems retained full function or were upgraded as planned. There were no major complications and acute surgical referral was not required.
  
  
  CONCLUSIONS
  Angioplasty techniques may be used to maintain and increase the longevity of transvenous pacing pathways in young patients.
authors.affiliation: Department of Cardiology, Deutsches Kinderherzzentrum St. Augustin, Germany. p.zartner@asklepios.com
authors.forename: Peter
authors.initials: P
authors.lastname: Zartner
authors.forename: Nicole
authors.initials: N
authors.lastname: Toussaint-Goetz
authors.forename: Walter
authors.initials: W
authors.lastname: Wiebe
authors.forename: Martin
authors.initials: M
authors.lastname: Schneider
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000800:Angioplasty, Balloon / Q000295:instrumentation; D016121:Brachiocephalic Veins / Q000000981:diagnostic imaging; D002304:Cardiac Pacing, Artificial / Q000009:adverse effects; D002405:Catheterization, Central Venous / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D003251:Constriction, Pathologic; D020878:Device Removal; D005858:Germany; D006330:Heart Defects, Congenital / Q000628:therapy*; D006801:Humans; D010138:Pacemaker, Artificial / Q000009:adverse effects; D010690:Phlebography; D012189:Retrospective Studies; D012720:Severity of Illness Index; D015607:Stents; D013479:Superior Vena Cava Syndrome / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D013997:Time Factors; D016896:Treatment Outcome; D014652:Vascular Diseases / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D014654:Vascular Patency; D055815:Young Adult