Superior Vena Cava Syndrome Caused by Pacemaker Leads. Ann Thorac Surg. 2016;101:2358-2361. [PMID: 27211943 DOI: 10.1016/j.athoracsur.2015.09.006]

Leadless pacemakers as a new alternative for pacemaker lead-related superior vena cava syndrome: A case report

Superior vena cava (SVC) syndrome is a rare disease induced by thrombosis and consequent occlusion of SVC, negatively affecting morbidity and mortality. The incidence of SVC syndrome from central venous catheters and pacemaker or defibrillator leads is increasing. Optimal treatment of pacemaker or defibrillator-related SVC syndrome is not well defined. Lead extraction causes mechanical trauma to the vessel wall. In addition, subsequent device implantation on the contralateral side can be an added factor for venous occlusion. The use of leadless pacemakers could be an interesting option to reduce the risk of SVC restenosis after lead extraction. We report a clinical case of PM leads-related SVC syndrome referred to our centers and treated with transvenous lead extraction, leadless pacemaker implantation and subsequent percutaneous angioplasty and stenting of the SVC and left innominate vein.

Successful upgrade to cardiac resynchronization therapy for cardiac implantation-associated left subclavian vein occlusion: A case report

BACKGROUND

Subclavian vein stenosis or occlusion may be caused by a transvenous pacemaker, which makes the reimplantation of a new pacemaker lead difficult. Transvenous pacemaker lead implantation-related subclavian vein occlusion may present difficulty with regard to cardiac resynchronization therapy (CRT) upgrade.

CASE SUMMARY

We report the case of a 46-year-old man who was admitted with total subclavian vein occlusion caused by a permanent pacemaker that had been implanted 2 years previously. We successfully treated this patient with an upgrade to a CRT pacemaker by utilizing transferable interventional coronary and radiological techniques. The patient recovered uneventfully during the follow-up period.

CONCLUSION

CRT upgrade is still a viable technique for the treatment of subclavian vein obstruction caused by previous pacemaker implantation.

Acute Hemodynamic Compromise following Superior Vena Cava Stent Placement: A Case Report

Symptomatic relief of Superior Vena Cava (SVC) syndrome caused by tumor obstruction is achieved by the placement of a percutaneous superior vena cava stent. Complications are rare. Even more uncommon is acute hemodynamic compromise from acute hemopericardium during placement of an SVC stent. Point of Care Ultrasound (POCUS) in the Interventional Radiology Suite (IR) suite allows for rapid diagnosis and guidance of pericardial drainage and hemodynamic management.

Lead-related superior vena cava syndrome: Management and outcomes

BACKGROUND

Superior vena cava (SVC) syndrome includes the clinical sequalae of facial and bilateral upper extremity edema, dizziness, and occasional syncope. Historically, most cases have been associated with malignancy and treatment is palliative. However, cardiac device leads have been identified as important nonmalignant causes of this syndrome. There are little data on the effectiveness of venoplasty and lead extraction in the management of these patients.

OBJECTIVE

The objective of this study was to report the findings associated with the use of balloon angioplasty and lead extraction in the management of 17 patients with lead induced SVC syndrome.

METHODS

Data collected from January 2003 to July 2019 identified 17 cases of SVC syndrome at our tertiary center. Their outcomes were compared to a control group of patients without SVC syndrome. A P value of <.05 was considered statistically significant.

RESULTS

Of the 17 patients, 13 (76%) underwent transvenous lead extraction and venoplasty. Three patients (18%) were treated with venoplasty alone, and 1 patient (6%) underwent surgical SVC reconstruction. In 10 patients (59%), transvenous reimplantation was necessary. Symptom resolution was achieved in all 17 patients and confirmed at both 6 and 12 months' follow-up. There was no significant difference in the rate of complications associated with transvenous lead extraction for SVC syndrome vs control.

CONCLUSION

In patients with SVC syndrome, venoplasty and lead extraction are safe and effective for resolution of symptoms and maintaining SVC patency.

Innominate Vein Injury Secondary to First-Time Sternotomy

Innominate vein injury is a known potential complication of redo sternotomy, but transection of the innominate vein after first-time median sternotomy has not been previously described. A 71-year-old woman experienced left innominate vein transection upon division of the sternum for coronary artery bypass grafting. Subsequent massive bleeding required digital compression of the transected vessel ends, open manual cardiac massage, institution of a massive transfusion protocol, and pharmacologic support before hemodynamic control was gained by instituting cardiopulmonary bypass. Left innominate vein injury can occur with both first-time and redo sternotomy.

Cranial Vena Cava Syndrome in Guinea Pigs with Chronic Jugular Vein Catheters

Guinea pigs are a premier small animal model for infectious disease research, and chronic indwelling venous access ports may be used to facilitate various procedures. Here we report catheter-related lesions in 5 uninfected Dunkin-Hartley guinea pigs with chronic jugular vein catheters used for imaging studies. Three guinea pigs were found dead with no premonitory signs. At necropsy, there was severe bilateral pulmonary atelectasis due to 20 to 29 mL of pleural effusion resulting from catheter-related thrombosis and cranial vena cava syndrome. In addition, one of these 3 guinea pigs had a polymicrobial catheter infection with abscessation. A 4th clinically normal guinea pig was euthanized at the end of the study, having spontaneously lost its catheter 7 mo prior, and had 17 mL of pleural effusion. The 5th guinea pig was euthanized following pooling of contrast material around the distal catheter in the cranial vena cava on CT. By histology, affected animals had recent and remote thrombosis or fibrosis (or both) of the cranial vena cava and right atrial wall, with osseous and cartilaginous metaplasia. Cranial vena cava syndrome should be considered as a differential for dyspnea or death in chronically catheterized laboratory animals.

[Progress on the Therapeutic Approaches for Malignant Tumor with Superior Vena Cava Syndrome]

上腔静脉综合症（superior vena cava syndrome, SVCS）作为胸部恶性肿瘤严重的并发症之一，患者生存期短、生活质量差，大部分采用姑息治疗，随着多学科的发展与治疗技术的进步，越来越多的专家采用各种治疗方式，明显改善了患者的预后，本文对病因表现进行简单归纳，并从内科治疗、介入治疗、放射治疗、外科手术治疗以及质子治疗等几个方面对目前较新的治疗方式进行综述。