EJIMA KOICHIRO
   Department   School of Medicine(Tokyo Women's Medical University Hospital), School of Medicine
   Position   Associate Professor (Fixed Term)
Article types Case report
Language English
Peer review Peer reviewed
Title Left brachiocephalic vein occlusion in a patient with an aortic arch aneurysm: Rare cause of obstraction for a pacemaker implantation
Journal Formal name:Journal of Cardiology Cases
Abbreviation:J Cardiol Cases
ISSN code:18785409
Domestic / ForeginDomestic
Publisher published by Elsevier B. V. on behalf of the Japanese College of Cardiology
Volume, Issue, Page 9(1),32-34頁
Author and coauthor EJIMA Koichiro†*, SHODA Morio, MANAKA Tetsuyuki, YASHIRO Bun, KATO Ken, YOSHIDA Kentaro, NUKI Toshiaki, HAGIWARA Nobuhisa
Publication date 2014/01
Summary Venous occlusions or anatomic variants are unexpectedly encountered during transvenous pacing lead implantation procedures. A 78-year-old man, who had been medically treated for a thoracic and abdominal dissecting aortic aneurysm was referred to our hospital for treatment of congestive heart failure due to complete atrioventricular block with bradycardia. At the time of the pacemaker implantation, the guidewire for inserting the introducer sheath could not be advanced into the left brachiocephalic vein. A venogram and contrast-enhanced chest multi-detector computed tomography revealed an obstruction of the left brachiocephalic vein at the confluence of the left internal jugular and left subclavian veins, and there was collateral blood circulation. We abandoned introducing the pacemaker lead from the left side, and implanted the pacemaker in his right anterior chest. In this case, the left brachiocephalic vein was occluded due to dilatation and elongation of the aortic arch aneurysm and the deviated left common carotid artery. This case illustrates the importance of the assessment of the patency of the left brachiocephalic vein prior to the central venous approach from the left internal jugular and left subclavian veins in patients with aortic arch aneurysms. <Learning objective: Venous occlusions or anatomic variants are unexpectedly encountered during transvenous pacing lead implantation procedures. Dilatation and elongation of the aortic arch aneurysm and the deviated left common carotid artery can be a cause of a left brachiocephalic vein occlusion. It is important to assess the patency of the left brachiocephalic vein prior to the central venous approach from the left internal jugular and left subclavian veins in patients with aortic arch aneurysms.>.
DOI 10.1016/j.jccase.2013.09.003
PMID 30546779