University of Miami Miller School of Medicine, Miami, Florida.
The Heart Institute at Palmetto General Hospital, Palmetto General Hospital, Hialeah, Florida.
Heart Rhythm. 2021 Feb;18(2):207-214. doi: 10.1016/j.hrthm.2020.09.006. Epub 2020 Sep 11.
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.
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.
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.
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.
In patients with SVC syndrome, venoplasty and lead extraction are safe and effective for resolution of symptoms and maintaining SVC patency.
上腔静脉（SVC）综合征包括面部和双侧上肢水肿、头晕和偶尔晕厥等临床后遗症。历史上，大多数病例与恶性肿瘤有关，治疗方法是姑息性的。然而，心脏装置导线已被确定为导致这种综合征的重要非恶性原因。关于球囊血管成形术和导线提取术在这些患者管理中的有效性的数据很少。
本研究旨在报告在管理 17 例因导线引起的 SVC 综合征患者中使用球囊血管成形术和导线提取术的发现。
从 2003 年 1 月至 2019 年 7 月收集的数据在我们的三级中心确定了 17 例 SVC 综合征病例。将他们的结果与没有 SVC 综合征的对照组患者进行比较。P 值<.05 被认为具有统计学意义。
在 17 例患者中，13 例（76%）接受了经静脉导线提取和血管成形术。3 例（18%）单独接受了血管成形术治疗，1 例（6%）接受了 SVC 重建手术。在 10 例患者（59%）中，需要经静脉重新植入。所有 17 例患者的症状均得到缓解，并在 6 个月和 12 个月的随访中得到证实。SVC 综合征与对照组患者相比，经静脉导线提取相关并发症的发生率没有显著差异。
在 SVC 综合征患者中，血管成形术和导线提取术是安全有效的，可以缓解症状并保持 SVC 通畅。
