Percutaneous balloon venoplasty for symptomatic lead-related venous stenosis

Lead-related venous stenosis (LRVS) is common after transvenous lead implantation and generally diagnosed incidentally. Symptomatic LRVS, causing discomfort and swelling, is less common.

We report on the management and outcomes of patients with symptomatic LRVS after percutaneous balloon venoplasty.

We included patients with symptomatic LRVS unresponsive to >30 days of anticoagulation who underwent venoplasty at the Hospital of the University of Pennsylvania between 2014 and 2020. Transvenous lead extraction (TLE) was performed first if the lesion could not be crossed with a wire.

Eighteen patients (mean age, 62 ± 10 years; 44% female) underwent 27 venoplasty procedures. Symptoms included arm swelling in 9 (50%), facial/neck swelling in 1 (6%), and both in 8 (44%). Venography revealed LRVS in the axillary/subclavian veins in 10 (56%), the brachiocephalic vein in 6 (33%), and the superior vena cava in 4 (11%). Most patients (83%) required TLE before venoplasty, and only 5 of 18 (28%) remained with leads crossing the stenosed segment. Thirteen patients (72%) had complete symptom resolution, 4 (22%) had partial resolution due to secondary lymphedema, and 1 showed no improvement. Patients with complete resolution had shorter times from symptom onset to intervention (195 vs 690 days; P = .02).

LRVS can affect any part of the venous system and may be manifested with swelling of the arm, face/neck, or both. Balloon venoplasty is safe and effective, often requires TLE, and is particularly durable when leads no longer cross the stenosed region. Venoplasty is less effective for secondary lymphedema, highlighting the need for timely intervention.