Abstract：
Superior vena cava (SVC) tear is the most lethal complication during transvenous lead extraction (TLE) with a mortality rate as high as 50%. Treatment involves aggressive attempts to maintain cardiac output and immediate sternotomy to localize and repair the vascular tear. Occlusion balloons have been developed to provisionally occlude the lacerated SVC and to provide hemodynamic stability allowing time for surgery. In case of mediastinal hematoma without hemodynamic instability, the strategy remains unclear.
We describe two cases of SVC tear during TLE. The first case was a 60-year-old man who presented with a right ventricular single-chamber defibrillator lead fracture and innominate vein stenosis. The RV lead was removed using a laser sheath causing a mediastinal hematoma with no active bleeding during surgical exploration few hours later. The second case was a 28-year-old man that presented with a right atrial (RA) lead fracture and RV lead insulation failure in a dual-chamber defibrillator (ICD).
Both the RA and RV leads were removed with mechanical sheaths, and a mediastinal hematoma was medically managed.
We describe two cases of SVC tear during TLE. The first case was a 60-year-old man who presented with a right ventricular single-chamber defibrillator lead fracture and innominate vein stenosis. The RV lead was removed using a laser sheath causing a mediastinal hematoma with no active bleeding during surgical exploration few hours later. The second case was a 28-year-old man that presented with a right atrial (RA) lead fracture and RV lead insulation failure in a dual-chamber defibrillator (ICD).
Both the RA and RV leads were removed with mechanical sheaths, and a mediastinal hematoma was medically managed.
摘要：
背景：上腔静脉（SVC）撕裂是经静脉引线拔除（TLE）过程中最致命的并发症，死亡率高达50％。治疗包括积极尝试维持心输出量和立即胸骨切开术以定位和修复血管撕裂。已经开发了封闭球囊以暂时封闭撕裂的SVC并提供血液动力学稳定性，从而有时间进行手术。如果纵隔血肿没有血流动力学不稳定，战略尚不清楚。
结果：我们描述了2例TLE期间SVC撕裂。第一例是一名60岁的男子，他表现为右心室单腔除颤器导线骨折和无名静脉狭窄。使用激光鞘去除RV导线，导致纵隔血肿，数小时后手术探查期间无活动性出血。第二例是一名28岁的男子，在双腔除颤器（ICD）中出现右心房（RA）导线断裂和RV导线绝缘故障。
结论：RA和RV导线均采用机械护套移除，纵隔血肿得到了医学治疗。
结果：我们描述了2例TLE期间SVC撕裂。第一例是一名60岁的男子，他表现为右心室单腔除颤器导线骨折和无名静脉狭窄。使用激光鞘去除RV导线，导致纵隔血肿，数小时后手术探查期间无活动性出血。第二例是一名28岁的男子，在双腔除颤器（ICD）中出现右心房（RA）导线断裂和RV导线绝缘故障。
结论：RA和RV导线均采用机械护套移除，纵隔血肿得到了医学治疗。
