Safety and efficacy of combined dilation/stenting of venous abnormalities, including complete obstructions, during...

Area of Science:

• Cardiovascular Medicine
• Interventional Cardiology
• Congenital Heart Disease Management

Background:

• Management of transvenous leads in congenital heart disease (CHD) patients is challenging due to potential venous obstructions and shunts.
• Previous interventions often faced difficulties with complete venous obstructions.

Purpose of the Study:

• To evaluate the safety and efficacy of concurrent transvenous lead extraction and venous pathway dilation/stenting in CHD patients.
• To assess the combined procedure's effectiveness in resolving complex venous anomalies.

Main Methods:

• Retrospective review of eight patients undergoing concurrent lead extraction and venous recanalization (2017-2021).
• Procedures included dilation and stenting of vena cavae/baffles, addressing complete obstructions and other venous anomalies.

Main Results:

• All eight patients (median age 38.5 years) with CHD had complete lead extractions, with a median lead dwell time of 13.8 years.
• Three patients had complete venous obstructions, and interventions included stenting of innominate veins and femoral vessel recanalization.
• The median procedure time was 9.8 hours, with complications including transfusion and arrhythmia; no deaths or major vascular injuries occurred.

Conclusions:

• Concurrent lead extraction and venous dilation/stenting is an effective strategy for managing complex venous issues in CHD patients.
• This combined approach safely resolves complete venous obstructions associated with transvenous leads.
• Despite lengthy procedure times, the intervention offers a viable solution with minimal complications.