# Innominate Vein Thrombosis: A Case Report and Literature Review

## TL;DR

This case report describes a rare instance of brachiocephalic vein thrombosis in an elderly patient with multiple medical conditions, highlighting the importance of pre-procedural imaging and careful planning.

## Contribution

The report emphasizes the use of CT venography and leadless ICD technology to manage patients with limited venous access and multiple risk factors.

## Key findings

- Chronic brachiocephalic vein thrombosis was discovered during an ICD placement procedure in an 82-year-old woman.
- A multidisciplinary approach enabled successful ICD placement and anticoagulation therapy in a high-risk patient.
- Pre-procedural imaging and leadless ICD technology are recommended for patients with limited venous access.

## Abstract

The brachiocephalic vein (BCV), also known as the innominate vein, is a central vein in the upper chest formed by merging the internal jugular and subclavian veins. It plays a crucial role in venous return from the head, neck, and upper extremities and is significant in procedures such as pacemaker and implantable cardioverter-defibrillator (ICD) placement, chemotherapy ports, and central venous catheter insertions. The presence of foreign bodies and local malignancy are major risk factors for thrombosis in the BCV. As part of the deep venous system, BCV thrombosis (BCVT) is a rare condition but can lead to serious complications like superior vena cava syndrome and, rarely, pulmonary embolism. This case report presents an 82-year-old woman with a history of heart failure with reduced ejection fraction, coronary artery disease, atrial fibrillation, HIV, pulmonary embolism, systemic lupus erythematosus, and breast cancer who required an ICD placement due to persistent systolic dysfunction. During the procedure, chronic BCVT leading to the stenosis was incidentally discovered, necessitating urgent vascular intervention to establish venous patency. The patient’s complex medical history, including previous chemotherapy through a central venous catheter, contributed to the risk factors for BCVT. The multidisciplinary approach led to successful ICD placement and the reinstatement of anticoagulation therapy. This case underscores the rarity and severity of BCVT and highlights the importance of pre-procedural imaging, such as CT venography, in patients with multiple risk factors. Additionally, the report suggests considering leadless ICD technology for patients with limited venous access to avoid complications. The findings emphasize the critical need for thorough evaluation and planning in complex cases to ensure successful outcomes.