Abstract：
BACKGROUND: Data on transvenous (TV) lead-associated superior vena cava (SVC) syndrome are limited. The management of this problem might require a multidisciplinary approach, often involving transvenous lead extraction (TLE) followed by angioplasty and stenting.
OBJECTIVE: The purpose of this study was to describe the management and outcome of TV lead-associated SVC syndrome.
METHODS: We retrospectively identified patients with a diagnosis of SVC syndrome and TV leads at Emory Healthcare between 2015 and 2023.
RESULTS: Fifteen patients with lead-related SVC syndrome were identified. The cohort average age was 50 years. Symptoms included swelling of the face, neck, and upper extremities (67%); shortness of breath (53%); and lightheadedness (40%). Patients had an average of 2 ± 0.7 leads crossing the SVC, with a lead dwell time of 9.8 ± 7.5 years. Thirteen patients were managed with TLE, followed by SVC stenting and angioplasty in 10 and angioplasty alone in 2; 1 patient had no intervention after TLE. One patient was managed with anticoagulation, and another had angioplasty and stenting with lead jailing. One patient experienced SVC perforation and cardiac tamponade during SVC stenting, which was managed successfully with a covered stent and pericardiocentesis. Among the 12 patients with TLE and angioplasty ± stenting, 7 underwent reimplantation of a transvenous lead. Two of those patients had symptoms recurrence, and none of the 5 patients without lead reimplantation had recurrence of symptoms.
CONCLUSIONS: Lead-related SVC syndrome management requires a multidisciplinary approach often including TLE followed by angioplasty and stenting. Avoiding TV lead reimplantation might help reduce symptoms recurrence.
OBJECTIVE: The purpose of this study was to describe the management and outcome of TV lead-associated SVC syndrome.
METHODS: We retrospectively identified patients with a diagnosis of SVC syndrome and TV leads at Emory Healthcare between 2015 and 2023.
RESULTS: Fifteen patients with lead-related SVC syndrome were identified. The cohort average age was 50 years. Symptoms included swelling of the face, neck, and upper extremities (67%); shortness of breath (53%); and lightheadedness (40%). Patients had an average of 2 ± 0.7 leads crossing the SVC, with a lead dwell time of 9.8 ± 7.5 years. Thirteen patients were managed with TLE, followed by SVC stenting and angioplasty in 10 and angioplasty alone in 2; 1 patient had no intervention after TLE. One patient was managed with anticoagulation, and another had angioplasty and stenting with lead jailing. One patient experienced SVC perforation and cardiac tamponade during SVC stenting, which was managed successfully with a covered stent and pericardiocentesis. Among the 12 patients with TLE and angioplasty ± stenting, 7 underwent reimplantation of a transvenous lead. Two of those patients had symptoms recurrence, and none of the 5 patients without lead reimplantation had recurrence of symptoms.
CONCLUSIONS: Lead-related SVC syndrome management requires a multidisciplinary approach often including TLE followed by angioplasty and stenting. Avoiding TV lead reimplantation might help reduce symptoms recurrence.
摘要：
背景：经静脉（TV）导线相关上腔静脉（SVC）综合征的数据有限。这个问题的管理可能需要多学科的方法，通常涉及电视引线提取（TLE），然后进行血管成形术和支架置入。
目的：描述电视导联相关SVC综合征的治疗和结果方法：我们回顾性地确定了2015年至2023年在EmoryHealthcare诊断为SVC综合征和电视导联的患者。
结果：确定了15例铅相关性SVC综合征患者。队列平均年龄为50岁。症状包括面部肿胀，脖子,上肢（67%），呼吸急促(53%)和头晕(40%)。患者平均有2±0.7个引线穿过SVC，引线停留时间为9.8±7.5年。13例患者接受了经静脉引线拔除（TLE）治疗，其次是SVC支架置入术和血管成形术（10），单独血管成形术(2)，而一名患者在TLE后没有干预。一名患者接受了抗凝治疗，另一个人进行了血管成形术和支架置入术，并进行了铅监禁。一名患者在SVC支架置入过程中经历了SVC穿孔和心脏压塞，并成功使用覆膜支架和心包穿刺术。在TLE和血管成形术±支架置入术的12例患者中，7例患者接受了经静脉导线的再植入。其中2例出现症状复发，5例没有导线再植入的患者均未出现症状复发。
结论：导联相关SVC综合征治疗需要多学科方法，通常包括TLE，然后进行血管成形术和支架置入术。避免TV导线再植入可能有助于减少症状复发。
目的：描述电视导联相关SVC综合征的治疗和结果方法：我们回顾性地确定了2015年至2023年在EmoryHealthcare诊断为SVC综合征和电视导联的患者。
结果：确定了15例铅相关性SVC综合征患者。队列平均年龄为50岁。症状包括面部肿胀，脖子,上肢（67%），呼吸急促(53%)和头晕(40%)。患者平均有2±0.7个引线穿过SVC，引线停留时间为9.8±7.5年。13例患者接受了经静脉引线拔除（TLE）治疗，其次是SVC支架置入术和血管成形术（10），单独血管成形术(2)，而一名患者在TLE后没有干预。一名患者接受了抗凝治疗，另一个人进行了血管成形术和支架置入术，并进行了铅监禁。一名患者在SVC支架置入过程中经历了SVC穿孔和心脏压塞，并成功使用覆膜支架和心包穿刺术。在TLE和血管成形术±支架置入术的12例患者中，7例患者接受了经静脉导线的再植入。其中2例出现症状复发，5例没有导线再植入的患者均未出现症状复发。
结论：导联相关SVC综合征治疗需要多学科方法，通常包括TLE，然后进行血管成形术和支架置入术。避免TV导线再植入可能有助于减少症状复发。
