Stent dilation of superior vena cava and innominate vein obstructions permits transvenous pacing lead implantation

Frank Ing, Charles E. Mullins, Ronald G. Grifka, Michael R. Nihill, Arnold L. Fenrich, Elizabeth L. Collins, Richard A. Friedman

Research output: Contribution to journalArticle

44 Scopus citations

Abstract

The purpose of this study was to assess the feasibility of stent dilation of venous obstructions/occlusions to permit transvenous pacing lead implantation. Innominate vein or superior vena cave (SVC) obstruction may preclude the implantation of transvenous pacing leads. Patients with d- transposition of the great arteries, after a Mustard or Senning procedure, an d children with previously placed transvenous pacing leads are at higher risk for this vascular complication. From May 1993 to January 1996, eight pediatric patients who underwent transvenous pacing lead implantation or replacement were found to have significant innominate vein or SVC obstruction or occlusion. Utilizing intravascular stents, a combined interventional and electrophysiological approach was used to relieve the venous obstruction and to permit implantation of a new transvenous pacing lead. Two patients had complete SVC occlusion requiring puncture through the obstruction with a transseptal needle. Vessel recanalization was achieved with balloon dilation and stent implantation. The remaining six patients had severe venous obstruction with a mean minimum diameter of 3.1 ± 3.3 min. The mean pressure gradient across the obstructed veins was 8.6 ± 7.3 mmHg. Following implantation of 15 Palmaz P308 stents in eight vessels, the mean diameter increased to 14.2 ± 1.9 mm and the mean pressure gradient across the stented vessels decreased to 1.0 ± 2.0 mmHg. A transvenous pacing lead was implanted successfully through the stent(s) immediately or 6-8 weeks later. Innominate vein and SVC obstruction can be safely and effectively relieved with intravascular stents and permit immediate or subsequent transvenous pacing lead implantation.

Original languageEnglish (US)
Pages (from-to)1517-1530
Number of pages14
JournalPACE - Pacing and Clinical Electrophysiology
Volume21
Issue number8
DOIs
StatePublished - Aug 24 1998
Externally publishedYes

Keywords

  • Innominate vein
  • Obstruction
  • Pacing
  • Stents
  • Superior vena cava

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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