Abstract 18297: Transvenous Lead Extraction in Patients With Venous Stenosis is Associated With Increased Risk of Vascular Injury - An Analysis of the Nationwide Inpatient Sample

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Introduction: Venous stenosis is a recognized complication following the implantation of an ICD or a pacemaker. Venous obstruction of ipsilateral access vein poses some technical challenges during transvenous lead extraction (TLE) and may require advanced extraction tools. We analyzed the Nationwide Inpatient Sample database to study the reported incidence of venous stenosis during TLE and its impact on outcomes.

Hypothesis: Presence of venous stenosis during lead extraction is associated with adverse outcomes.

Methods: Data from Nationwide Inpatient Sample was queried to identify all TLE during from 2009 to 2012 using the appropriate ICD-9 codes. We then identified the patients in whom central vein stenosis was reported based on appropriate ICD-9 codes. We compared the in-hospital outcomes of the patients with and without venous stenosis.

Results: An estimated 107,036 TLE were performed from 2009 to 2012, and 1.1% (n=1,131) of patients was found to have associated with venous stenosis. Chronic kidney disease is associated with higher incidence of venous stenosis (OR=1.31, p=0.0001), whereas obesity (OR=0.66, p=0.003) and hypertension (OR=0.94, p<0.0001) were associated with lower incidences of venous stenosis (Table 1). Presence of venous stenosis during TLE is associated with higher risk of vascular injury (9.5% vs. 2.4%, p<0.0001). However, there was no significant difference in in-hospital mortality (1.8% vs. 1.9%), pericardial complications (2.6% vs. 1.9%), or median length of stay (4-days vs. 4-days) between patients with and without venous stenosis.

Conclusions: Presence of venous stenosis during TLE is associated with increased vascular injury, but was not associated with any significant difference in in-hospital mortality, pericardial injury, or length of stay.

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