Clinical significance of collateral superficial vein across clavicle in patients with cardiovascular implantable electronic device.
BACKGROUND
Obstruction of the access vein is a well-known complication after cardiovascular implantable electronic device (CIED) implantation. In that case, well-developed collateral superficial veins are frequently observed on the skin surface around the CIED. The aim of this study was to clarify the relationship between venous obstruction and development of a superficial vein across the clavicle.


RESULTS
A total of 107 patients scheduled for generator replacement, device upgrade, or lead extraction were enrolled. The skin surface around the device was photographed. A 20-ml bolus of contrast medium was injected into a peripheral arm vein on the side of CIED implantation, and contrast venography was performed. Venous obstruction was defined as luminal diameter narrowing >75%. Venography showed venous obstruction in 27 patients (25.2%). There were no statistically significant differences in patient characteristics between the venous obstruction and no venous obstruction group. Of 107 patients, 44 (41.1%) had a superficial vein across the clavicle on the side of CIED implantation. The sensitivity of the presence of a superficial vein across the clavicle in the diagnosis of venous obstruction was 96.3% and specificity was 77.5% (P<0.001).


CONCLUSIONS
The presence of a superficial vein across the clavicle is useful for the prediction of venous obstruction in patients with CIED.
Department of Cardiology, Yokohama City University Hospital.
Junya
J
Hosoda
Toshiyuki
T
Ishikawa
Kohei
K
Matsushita
Katsumi
K
Matsumoto
Teruyasu
T
Sugano
Tomoaki
T
Ishigami
Kazuo
K
Kimura
Satoshi
S
Umemura
D000368:Aged; D000369:Aged, 80 and over; D002968:Clavicle / Q000098:blood supply*; D017147:Defibrillators, Implantable; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010690:Phlebography / Q000379:methods; D014652:Vascular Diseases / Q000000981:diagnostic imaging* / Q000209:etiology