Introduction: Severe stenosis or occlusion of superior cava vein (SCV) consist rare but terrible complication of permanent lead dwelling in vascular bed. It may cause difficult the new lead implantation or to cause wide spectrum of clinical symptoms.
Objectives: The analysis of frequency of appearance of stenosis or occlusion of superior cava vein (SCV) in patients (pts.) referred for transvenous lead extraction (TLE).
Results: During last 7y. we extracted 2167 leads in 1283 pts. due to infective (49,5%) or non-infective indications (50,5%). In 183 pts. occlusion subclavian / anonymous vein (or both of them) were recognised but only in 32 (2,5%) narrowing affected of SCV. 7 pts presented full clinical picture of SCV syndrome, in 4 – incomplete symptoms of SCV syndrome and in remained 21 asymptomatic clinically. In 6 pts narrowing was limited to local of SCV fragment and in 26 narrowing was accompanied by anonymous vein occlusion and was located below anonymous vein. Permanent mechanical local irritation of SVCV wall (roundel lead loop or dislodged J shape lead ending) have been considered in 5 pts, crossing of multiple lead implanted with both side of the chest in another 5 pts and previous ineffective attempt of simple traction in 2 pts. seems to be mechanism of local thrombosis ant later strong connecting tissue scar. Among 4 mid-symptomatic patients in 3 vena azygos consisted main drainage of upper part of the body. In 1 asymptomatic patient this role played preserved left SCV. In 9 of patients lead replacement with elimination lead loops in SCV overmuch of leads passing SCV slightly improved local venous return but in most of the pts. TLE procedure with following lead replacement in spite of subjective symptoms reduction does not change postoperative venography picture. It is very important that in all pts. standard lead introducer set was to short for the new lead implantation and non-standard longer set had to been utilized or even the new lead was introduced via polipropylene Byrd dilator directly after old lead extraction.
Conclusions: Severe stenosis or occlusion of superior cava vein consist rare complication of permanent pacing (2,4% among pts. referred for TLE). Patients with SCV syndrome consists about 0,5% of pts referred for TLE. Venous angioplasty with stenting of SCV brings positive but not always permanent effects. Unrecognised stenosis or occlusion of superior cava vein may to consist severe trap during lead replacement because longer introducer set have to be utilised.