ICD Leads Extraction and Clearing of Access Way in a Patient With Superior Vena Cava Syndrome

Abstract

Central vein disease is defined as at least 50% narrowing up to total occlusion of central veins of the thorax including superior vena cava, brachiocephalic, subclavian, and internal jugular vein. Thrombosis due to intravascular leads occurs in approximately 30% to 45% of patients early or late after implantation of a pacemaker by transvenous access.In this case, we report a male patient, 65-years old, hypertensive, type 2 diabetic, with atherosclerotic disease, coronary artery disease, underwent coronary artery bypass surgery in the past 10 years, having already experienced an acute myocardial infarction, bearer automatic implantable cardioverter defibrillator for 8 years after an episode of aborted sudden death due to ischemic cardiomyopathy, presenting left superior vena cava syndrome. The use of clopidogrel and rivaroxaban for over a year had no benefit on symptoms improvement.After atrial and ventricular leads extraction, a new shock lead was positioned in the right ventricle using active fixation and a new atrial lead was positioned in the right atrium, passing inside of the stents. Two days after the procedure the patient was asymptomatic and was discharged.

3 Cases of Superior Vena Cava Syndrome Following Percutaneous Right Ventricular Assist Device Placement

“…Venous scarring from preexisting intravascular leads may result in reduced distensibility and may precipitate venous congestion after percutaneous RVAD cannulation. For example, SVC syndrome following pacemaker implantation can occur secondary to the formation of vegetations or via thrombosis after endothelial disruption ( 7 ). In all 3 cases, the patients had longstanding intravascular leads in place, and 2 patients had leads removed before cannulation.…”

Neointimal fibrotic lead encapsulation – Clinical challenges and demands for implantable cardiac electronic devices

“…The (presumably always thrombotic) occlusion is often not clinically apparent at first [77] due to the formation of venous collaterals [27,28,34,77,78] (Fig. 2A).…”

The Use of Transvenous Lead Extraction of Non-Infected Leads to Prevent Long-Term Lead-Related Complications

“…Transvenous lead extraction (TLE) has been established as a safe and effective method of lead removal with a high rate of procedural success and a low level of major complications. If it is not possible to use TLE, a hybrid approach has already proven its efficacy and safety [20][21][22][23].…”