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 Figure 4 – Risk factors for the occurrence of significant venous lesions (> 50% of obstruction of blood vessel lumen) and/or presence of collateral circulation. Variables OR (IC 95%) p Male Age ≥ 60 years Chagas disease Ischemic cardiopathy Non-ischemic cardiopathy FC NYHA III-IV Use of anticoagulants Use of antiplatelet agents ICD lead CIED side (right) Time of implant ≥ 14 years Transvenous lead ≥ 3 LVEF < 55 Previous reoperations 0 1 2 3 4 5 6 7 8 9 10 11 0.76 (0.35 – 1.67) 1.12 (0.51 – 2.45) 1.75 (0.60 – 5.09) 2.33 (0.53 – 10.34) 0.77 (0.27 – 2.16) 1.24 (0.47 – 3.26) 1.31 (0.39 – 4.44) 1.23 (0.54 – 2.82) 1.24 (0.48 – 3.15) 1.57 (0.71 – 3.45) 0.82 (0.26 – 2.59) 0.73 (0.15 – 3.49) 1.80 (0.75 – 4.34) 0.89 (0.41 – 1.94) 0.495 0.776 0.304 0.265 0.062 0.669 0.666 0.625 0.659 0.263 0.733 0.691 0.189 0.761 Odds Ratio Table 5 – Agreement between the surgical strategy defined using preoperative venography and the surgical procedure performed Surgical planning Cases planned Cases performed • Venous stenosis < 50% to moderate stenosis 76 75 Direct access through the cephalic subclavian/cephalic vein • Severe stenosis or occlusion, with jugular vein and/or brachiocephalic trunk without obstructive lesions 11 11 Access through internal jugular vein • Severe stenosis or occlusion, with jugular vein and/or brachiocephalic trunk with obstructive lesions 13 14 Lead extraction The high prevalence of individuals with lesions deemed significant in this study was compatible with other experiences reported in the literature. 1-11 Regardless of lesion seriousness, their distribution was balanced among the subclavian veins, the venous brachiocephalic trunk or the transitional areas of those veins. Despite the particularities existing among the anatomy of the veins draining the left side and the right side of the thorax, the venographic study did not identify significant differences in the frequency of those findings, in how serious the stenosis was, or in the location of the lesions between the two sides. However, there were differences in the average time leads had remained implanted, i.e., longer for patients who had the device implanted on the right side, which may have increased the rate of occurrences of lesions in the right territory. On the other hand, despite the balance between the numbers of leads implanted, the number of defibrillator leads, which is deemed a risk factor for venous lesions, was significantly higher in the cases where the CIED had been implanted on the left side. 1-4-8 The strong association between the presence of collateral circulation and severe or occlusive venous lesions, which was observed in this study, is quite useful to interpret venographies. Therefore, we can say that whenever there is collateral circulation, lesions difficult to be defined have to be carefully 693