Types of left brachiocephalic vein aberrations detected during cardiac implantable electronic device implantation procedures

Abstract

Background: Cardiac implantable electronic device (CIED) implantation procedures with transvenous lead placement afford an opportunity to observe vascular anatomic variations. The course of CIED implantation depends largely on morphometric and topographic characteristics of the relevant brachiocephalic vein (BCV), which is the left BCV in the case of lead insertion via the left clavipectoral triangle. This study aims to present left BCV anomalies arising from abnormal systemic vein embryogenesis and encountered during CIED implantation. Materials and methods: Venograms obtained during CIED implantation procedures and illustrating left BCV topography/morphometry were analysed retrospectively for two types of anomalies: anomalies of the left BCV itself (data from the period 2014–2018) and a combination of left BCV variations with a persistent left superior vena cava (PLSVC); since the latter instances are rare, the analysed period was longer (2003–2018). Results: Analysis of data from the first, 5-year-long, period included data from a group of 1812 patients and revealed 5 (0.3%) cases of developmental left-BCV anomalies (3 double left BCV and 2 cases of a single subaortic left BCV). The 16-year-long analysed period included 6110 CIED implantation procedures, which showed 12 (0.2%) cases of PLSVC including 4 (33%) cases of left BCV agenesis. Conclusions: The analysed venograms rarely showed isolated left-BCV aberrations (0.3%), with the combination of left-BCV agenesis and PLSVC being much more common (33%). The morphometry and/or topography of aberrant left-BCV may result in difficulties during cardiac lead insertion.