ABC | Volume 111, Nº5, November 2018

Original Article Albertini et al The role of preoperative venography in reoperations Arq Bras Cardiol. 2018; 111(5):686-696 blood vessel lumen), only 4 had collateral circulation. On the other hand, out of the 24 individuals with venous lesion deemed severe or with venous occlusion, just 2 did not present collateral circulation in their venography. Therefore, finding collateral circulation in venography was observed to be a strong marker of the presence of venous lesion, increasing 4.9 times the prevalence rate (CI 95% 3.05 – 8.10; p < 0.0001) of those lesions (Figures 2 and 3). Despite the differences of time since implantation and types of devices implanted, there was balance between the findings of venous lesions (p = 0.865) and of collateral circulation (p = 0.715) in patients with devices implanted on the right and left sides. Regardless of the side the CIED had been implanted, subclavian veins and the transition from subclavian veins to the brachiocephalic trunk were the regions that presented the highest number of significant lesions (Table 3). No significant lesions were identified in the superior vena cava. Indication of surgical procedure The main reason to perform a surgical procedure was lead dysfunction, in 71 patients. Upgrade procedures was the cause of reoperation in 25 cases. Only for 4 patients the operation was caused solely by a need of lead removal (Table 4). Leads were removed from52 patients. Transvenous extraction with mechanical or laser sheaths was performed in 36 patients, while leads were removed through simple traction in just 16 cases. At the end of the operation, only 4 patients remained without any transvenous lead implanted, and in most cases (90%), two or three leads remained in the venous territory. Figure 1 – Composition of the population studied and Study phases. Period: from April/2013 to July/2016 Reoperations involving leads (n = 289) Digital subtraction venography (n = 100) 189 individuals were not included • kidney failure (n = 110) • Transthoracic access (n = 41) • Age > 90 years (n = 20) • Iodine allergy (n = 3) • Cancer (n = 1) • Pregnancy (n = 2) • Refused to participate (n = 12) Surgical procedure (1) implant of additional leads; (2) Lead replacement; (3) Lead extraction 1) Venographic findings of significant venous obstructions and/or collateral circulation 2) Impact of venographic findings on planning and performing surgical procedure Inclusion Population composition Outcomes 689