Management of Lead-Related Superior Vena Cava Syndrome: Clinical and Procedural Outcomes

Superior vena cava syndrome (SVC) is an uncommon complication of transvenous leads (TVL). Management often involves removal of the TVL, venoplasty, and stenting in certain situations.

This study sought to define the management of lead-related SVC syndrome.

We identified patients with lead related SVC between 2014 and 2025 at Mayo Clinic sites. Demographic data, information regarding cardiac implantable electronic device, extraction procedure, and venoplasty procedure data were abstracted from the charts for analysis.

A total of 28 leads were present in 14 patients causing SVC syndrome. Median age of the study cohort was 61.0 (Q1-Q3: 45.8-66.8) years, and 50% were female. Median number of leads implanted per patient was 2.0 (Q1-Q3: 1-2) leads, and median age of the leads was 48.0 (Q1-Q3: 31.8-74.0) months. A total of 11 patients (78.6%) underwent extraction procedure, and all of them had complete procedural success without complications. Of the total cohort, 7 underwent venoplasty and 7 underwent stenting. During a median follow-up of 22.1 (Q1-Q3: 9.5-66.3) months, 5 patients (35.7%) had recurrent symptomatic stenosis (2 with index balloon venoplasty and 3 index transvenous lead extraction and venoplasty). Of the 11 patients who underwent extraction, 6 required reimplantation of the device: 2 transvenous, 2 epicardial, 1 subcutaneous, and 1 leadless device implantation.

Effective management of TVL-associated SVC syndrome involves venoplasty with or without transvenous lead extraction, showing good medium-term outcomes. Reimplantation of the device with TVL requires careful consideration, and efforts should be made to consider a leadless device when feasible.