Abstract 3026: Venography With Gaseous Carbon Dioxide To Assess Vessel Patency Prior To Addition Of Intracardiac Electrodes For Rhythm Control Devices When Iodinated Dye Is Contraindicated
Significant stenoses within the subclavian and/or innominate vessels are often encountered in patients (pts) with pacemaker (PM) and/or defibrillator (ICD) leads. These stenoses may impair venous access when the placement of one or more new leads is required. Contrast venography with iodinated dye is often performed to assess vessel patency prior to surgery. In settings where such imaging agents are contraindicated (e.g. chronic renal disease, allergic reactions, local inflammatory conditions), use of gaseous carbon dioxide (CO2) may be a reasonable alternative. We report the experience with 14 consecutive pts who underwent CO2 venography to assess vessel patency prior to proposed surgery. In each pt an 18 or 20 gauge Angiocath was placed in a left upper extremity vein at or above the antecubital fossa. Via a hand injection approximately 20 ml of CO2 were rapidly infused via CO2 primed injection tubing. Fluoroscopic imaging over the axillosubclavian region, lower neck and mediastinum was performed (6 frames/ second). Procedures under consideration prior to CO2 venography included: revision for preexisting pm lead malfunction - 2 pts; pm upgrade to ICD - 2 pts.; pm or ICD upgrade to cardiac resynchronization therapy -10 pts. Contraindications to standard dye use included: azotemia or chronic renal failure - 11 pts; history of dye allergy- 2 pts; preexisting local cellultitis - 1 pt. Surgery was performed uneventfully in 7 pts with no occlusive disease. A moderate venous occlusion was detected in one pt who underwent successful system revision with insertion of a new electrode via the contralateral subclavian venous system. Severe occlusions in 3 patients prompted avoidance of surgery with consideration of future extraction or epicardial lead placement. Three pts had normal venograms but did not have surgery, for unrelated reasons. None of the 14 pts who underwent CO2 venography experienced adverse effects related to the imaging agent.
Conclusion: Upper extremity venography using gaseous CO2 prior to pacemaker or ICD surgery involving placement of additional endocardial electrodes is an effective, safe, and reliable alternative to standard iodinated contrast venography.