Predicting Venous Occlusion in Patients with an Implanted Electronic
Cardiac Device
Abstract
Introduction - Over time, many patients with cardiac implanted devices
(CIED) require revision or addition of leads. Predicting patency of the
previously implanted vein is important in planning the procedure. The
purpose of this study was to examine the accuracy of inspection of the
skin overlying a previous CIED implant (usually the shoulder on the
implanted side) for prominence of collateral veins, as a predictor of
significant venous stenosis or obstruction. Methods - The shoulder area
of 38 patients undergoing any procedure related to a previously
implanted CIED was inspected by a physician who assigned a ‘collateral
score’ of 1-4. Venography was then performed and assessed by two
physicians, blinded to the assessment by physical examination. A
‘patency score’ was assigned (1-5). The predictive value of the
collateral score for venous patency or any degree of obstruction was
assessed. Results - The study included 38 patients. The area under the
ROC curve of collateral score as a predictor of any degree of
obstruction (patency score>1) was 0.859, indicating
excellent correlation. A collateral score of 1.75 yielded a sensitivity
of 78.9% and specificity of 88.6% for any degree of venous
obstruction. Conclusion - In patients with a previously implanted
cardiac device, patency of the implanted vein may be reliably predicted
by lack of collateral veins on inspection. Keywords - Pacemaker,
implanted device, lead revision, venous patency, physical examination