title: Use of radiofrequency energy and covered stents in patients with an occluded superior vena cava and requiring endocardial pacemaker implantation.
abstract: OBJECTIVE
  To evaluate the radiofrequency energy and covered stents in the percutaneous reconstruction of an interrupted superior vena cava in patients needing endocardial lead implantation.
  
  
  BACKGROUND
  Patients with a history of multiple cardiac surgical procedures or with an history of infections of the pacemaker (PM) site and electrodes may develop iatrogenic occlusion of the venous access.
  
  
  METHODS
  Three patients (40, 48 and 74 years old, respectively) needing endocardial pacemaker implantation had complete obstruction of the superior vena cava. Recanalization of the superior vena cava (SVC) was undertaken under general anesthesia with orotracheal intubation.
  
  
  RESULTS
  A total of 7 balloon-expandable Cheatham-Platinum 8 Zig covered stents were implanted, with a median fluoroscopy time of 58 minutes. The connection between the SVC and the right atrium was obtained, and PMs were implanted successfully in all cases. The patients' recovery was uneventful and they were discharged home 3 days later.
  
  
  CONCLUSIONS
  Radiofrequency energy and the use of covered stents may be very useful in patients with complete obstruction of the SVC, particularly in subjects needing endocardial PM implantation.
authors.affiliation: Pediatric Cardiology and GUCH Unit, Policlinico San Donato, IRCCS, Via Morandi, 30 San Donato Milanese (MI), Italy. gianfra.but@lycos.com
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Butera
authors.forename: Ezio
authors.initials: E
authors.lastname: Aim E
authors.forename: Mario
authors.initials: M
authors.lastname: Carminati
mesh_terms: D000328:Adult; D000368:Aged; D001145:Arrhythmias, Cardiac / Q000150:complications / Q000628:therapy; D017115:Catheter Ablation; D005260:Female; D006331:Heart Diseases / Q000150:complications / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial; D015607:Stents; D013479:Superior Vena Cava Syndrome / Q000150:complications / Q000628:therapy*; D014683:Vena Cava, Superior / Q000601:surgery*