Failure of Pacemaker Implantation Due to Occlusion of the Left Brachiocephalic Vein

左臂頭靜脈阻塞導致無法從左側置放心律調整器

李政翰(Cheng-Han Lee) ； 鄭莉莉(Li-Li Cheng) ； 吳俊明(Jing-Ming Wu) ； 林立人(Li-Jen Lin)

《Acta Cardiologica Sinica》 22卷1期 (2006/03) Pp. 31-34

摘要

臨床上，心臟科醫師通常從左鎖骨下置放永久性心律調整器。過程中，必須將心律調整器的導線經由左臂頭靜脈及上腔靜脈放至右心房或右心室。但是，如果左臂頭靜脈阻塞或先天性不存在且合併側支循環，盲目的置放心律調整器的導線將會導致不必要之併發症。在此提出一個臨床上極少見的85歲女性病例：我們在將導線經由鎖骨下靜脈通過左臂頭靜脈時，遇到阻力而失敗。初步透過左上臂靜脈顯影發現一極彎曲血管，後來透過多切面電腦斷層檢查發現，該病人的左臂頭靜脈全部阻塞並存在一相當彎曲且路徑很長的側枝靜脈而注入右上腔靜脈。最後我們成功的將心律調整器的導線經由右鎖骨下靜脈及右上腔靜脈放至右心房。

關鍵字

左臂頭靜脈阻塞 ； 置放心律調整器

並列摘要

Implantation of a permanent pacemaker by the transvenous approach might fail from the left side in a patient with abnormal left brachiocephalic vein, including occlusion, or congenital absence of coexisting collateral veins. We report an 85-year-old woman with occlusion of the left brachiocephalic vein accompanied by a large and repeated up-and-down course of the collateral vein draining into the superior vena cava (SVC) along the anterior margin of the aortic arch. Such an unusual venous anomaly was revealed during the procedure of implanting a permanent pacemaker. The course of the tortuous collateral vein was clearly demonstrated by multi-slice computed tomography. Finally, implantation was successful by using the right-sided venous access.

並列關鍵字

Anomaly of left brachiocephalic vein ； Permanent pacemaker implantation