title: Venous Stenosis After Transvenous Lead Placement: A Study of Outcomes and Risk Factors in 212 Consecutive Patients.
abstract: BACKGROUND
  Venous stenosis is a common complication of transvenous lead implantation, but the risk factors for venous stenosis have not been well defined to date. This study was designed to evaluate the incidence of and risk factors for venous stenosis in a large consecutive cohort.
  
  
  RESULTS
  A total of 212 consecutive patients (136 male, 76 female; mean age 69 years) with existing pacing or implantable cardioverter-defibrillator systems presented for generator replacement, lead revision, or device upgrade with a mean time since implantation of 6.2 years. Venograms were performed and percentage of stenosis was determined. Variables studied included age, sex, number of leads, lead diameter, implant duration, insulation material, side of implant, and anticoagulant use. Overall, 56 of 212 patients had total occlusion of the subclavian or innominate vein (26%). There was a significant association between the number of leads implanted and percentage of venous stenosis (P=0.012). Lead diameter, as an independent variable, was not a risk factor; however, greater sum of the lead diameters implanted was a predictor of subsequent venous stenosis (P=0.009). Multiple lead implant procedures may be associated with venous stenosis (P=0.057). No other variables approached statistical significance.
  
  
  CONCLUSIONS
  A significant association exists between venous stenosis and the number of implanted leads and also the sum of the lead diameters. When combined with multiple implant procedures, the incidence of venous stenosis is increased.
authors.affiliation: University of Iowa Division of Cardiology, Department of Medicine, Iowa City, IA (B.A.E.H., P.D.B., D.N.C., A.M., D.M.H.Z., V.C., M.C.G.).
authors.forename: Basil
authors.initials: B
authors.lastname: Abu-El-Haija
authors.affiliation: University of Iowa Division of Cardiology, Department of Medicine, Iowa City, IA (B.A.E.H., P.D.B., D.N.C., A.M., D.M.H.Z., V.C., M.C.G.).
authors.forename: Prashant D
authors.initials: PD
authors.lastname: Bhave
authors.affiliation: University of Iowa Division of Cardiology, Department of Medicine, Iowa City, IA (B.A.E.H., P.D.B., D.N.C., A.M., D.M.H.Z., V.C., M.C.G.).
authors.forename: Dwayne N
authors.initials: DN
authors.lastname: Campbell
authors.affiliation: University of Iowa Division of Cardiology, Department of Medicine, Iowa City, IA (B.A.E.H., P.D.B., D.N.C., A.M., D.M.H.Z., V.C., M.C.G.).
authors.forename: Alexander
authors.initials: A
authors.lastname: Mazur
authors.affiliation: University of Iowa Division of Cardiology, Department of Medicine, Iowa City, IA (B.A.E.H., P.D.B., D.N.C., A.M., D.M.H.Z., V.C., M.C.G.).
authors.forename: Denice M
authors.initials: DM
authors.lastname: Hodgson-Zingman
authors.affiliation: University of Iowa Division of Cardiology, Department of Medicine, Iowa City, IA (B.A.E.H., P.D.B., D.N.C., A.M., D.M.H.Z., V.C., M.C.G.).
authors.forename: Vlad
authors.initials: V
authors.lastname: Cotarlan
authors.affiliation: University of Iowa Division of Cardiology, Department of Medicine, Iowa City, IA (B.A.E.H., P.D.B., D.N.C., A.M., D.M.H.Z., V.C., M.C.G.).
authors.forename: Michael C
authors.initials: MC
authors.lastname: Giudici
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016121:Brachiocephalic Veins / Q000000981:diagnostic imaging; D003251:Constriction, Pathologic; D017147:Defibrillators, Implantable / Q000009:adverse effects*; D005260:Female; D006801:Humans; D015994:Incidence; D007484:Iowa / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial / Q000009:adverse effects*; D010690:Phlebography; D011474:Prosthesis Design; D019919:Prosthesis Implantation / Q000009:adverse effects* / Q000295:instrumentation; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013350:Subclavian Vein / Q000000981:diagnostic imaging; D013997:Time Factors; D016896:Treatment Outcome; D014652:Vascular Diseases / Q000175:diagnosis / Q000453:epidemiology*
keywords: implant techniques; pacing leads; venous stenosis