Superior Vena Cava Decompression After Complicated Stent Placement for Innominate Vein Obstruction in a VVI-ICD Patient.

OBJECTIVES

This report discusses the challenges and strategies involved in managing venous stenosis secondary to pacing or defibrillator leads, focusing on endovascular treatment options and procedural considerations.

KEY PROCEDURAL STEPS

Crucial steps of the procedure include thorough preprocedural planning, obtaining multisite venous access for optimal angiographic visualization, wiring through the stent using a percutaneous coronary intervention wire supported by a microcatheter and guiding catheter, confirming true lumen and intraluminal wire passage, and progressive ballooning using high-pressure balloons and kissing balloon technique.

POTENTIAL PITFALLS

Procedural complications include crushing of the pacing leads within the stent, incomplete stent expansion, and aggravation of existing stenosis. Ensuring correct wire trajectory and using multiple imaging modalities are critical to avoiding these issues.

TAKE-HOME MESSAGE: Venous stenosis related to pacing leads requires a multidisciplinary approach, with careful preprocedural planning and meticulous technique.