Superior vena cava syndrome and pacemaker leads. Explant by mechanical dissection system of extraction and percutaneous recanalization with stents for new device implantation

Abstract

Objective: Superior venous system stenosis (superior vena cava (SVC) -right subclavian vein -innominate vein -left subclavian vein) is a clinical situation that frequently appears in patients with long-term implanted cardiac stimulation devices, due to venous system thrombosis and in those with congenital heart disease who need corrective surgery, due to chronic complications inherent to surgical techniques. In clinical practice, venous system stenosis may manifest as a SVC syndrome. In many cases, we are not able to correct stenosis or obstructions, since it is impossible to cross them. In this article, we describe the surgical technique that we have implemented in our hospital to solve this challenge, especially in those patients with pacing/defibrillation devices who present with this pathology. Our objective was to perform an extraction of the pacemaker and defibrillation electrodes, to allow the passage of a support wire to achieve the implantation of the endovascular stent(s) to correct the SVC syndrome. Methods: We present a retrospective series of six consecutive patients with SVC syndrome studied in a single center from 2012 to 2021.Three of them presented with thrombosis related to pacing or defibrillation electrodes and the other three presented with complications derived from Mustard or Senning techniques in patients with pacemakers and D-transposition of the great arteries. Results: In all cases, a complete re-vascularization of the SVC system was achieved using a stent, and new leads could have been implanted through it. Combined treatment of lead extraction and endovascular stent implantation corrected the syndrome in all cases. Conclusions: Angioplasty and stenting of the central venous system is a standardized technique with validated results, in acute, for the recanalization of chronic occlusions secondary to transvenous devices.