Venoplasty-facilitated cardiac implantable electronic device implantation and upgrade: feasibility and outcomes from a single center

Venous occlusion represents a significant challenge during de novo implantation or upgrading of cardiac implantable electronic devices (CIEDs), particularly in patients with chronic transvenous leads. Venoplasty may restore venous access while avoiding contralateral implantation or transvenous lead extraction (TLE). To evaluate the feasibility, safety, and procedural outcomes of venoplasty in patients with venous obstruction undergoing de novo CIED implantation or device upgrade. In this single-center retrospective study, 12 patients (median age 69 years; 75% male) who underwent venoplasty for total or subtotal venous occlusion identified by venography between December 2022 and December 2024 were included. Two patients underwent de novo CIED implantation and ten underwent device upgrade procedures. Venoplasty was performed using antegrade or retrograde approaches under fluoroscopic guidance, followed by standard CIED implantation. Total venous occlusion was present in six patients and subtotal occlusion in six. The most common sites of obstruction were the brachiocephalic and subclavian veins. Antegrade venoplasty was successful in 11 patients, while retrograde femoral access was required in one case. Successful venous recanalization and CIED implantation were achieved in all patients (procedural success rate: 100%) without procedural complications. One patient developed subacute thrombosis related to anticoagulant non-compliance during follow-up. Venoplasty is a feasible, effective, and safe strategy for managing venous occlusion during de novo CIED implantation or device upgrade, reducing the need for contralateral access or TLE. This approach should be considered in appropriately selected patients at experienced centers.