title: ICD Leads Extraction and Clearing of Access Way in a Patient With Superior Vena Cava Syndrome: Building A Tunnel.
abstract: Central vein disease is defined as at least 50% narrowing up to total occlusion of central veins of the thorax including superior vena cava, brachiocephalic, subclavian, and internal jugular vein. Thrombosis due to intravascular leads occurs in approximately 30% to 45% of patients early or late after implantation of a pacemaker by transvenous access.In this case, we report a male patient, 65-years old, hypertensive, type 2 diabetic, with atherosclerotic disease, coronary artery disease, underwent coronary artery bypass surgery in the past 10 years, having already experienced an acute myocardial infarction, bearer automatic implantable cardioverter defibrillator for 8 years after an episode of aborted sudden death due to ischemic cardiomyopathy, presenting left superior vena cava syndrome. The use of clopidogrel and rivaroxaban for over a year had no benefit on symptoms improvement.After atrial and ventricular leads extraction, a new shock lead was positioned in the right ventricle using active fixation and a new atrial lead was positioned in the right atrium, passing inside of the stents. Two days after the procedure the patient was asymptomatic and was discharged.
authors.affiliation: From the Cardiac Surgery Division, Department of Medicine, Universidade Federal Fluminense, Niterói (MGK, GRDS); Cardiac Surgery Department (MGK, GRDS); Vascular Surgery Department, Hospital Regional Darcy Vargas, Rio Bonito, RJ, Brazil (RLLA, HBS); Department of Cardiology, Shanghai First People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China (SC); Fellowship of European Heart Rhythm Association/European Society of Cardiology, Department of Cardiology, Elisabethinen University Teaching Hospital Linz, Linz, Austria (SC); and Cardiology Division, Department of Medicine, Universidade Federal Fluminense, Niterói, RJ, Brazil (HVJ).
authors.forename: Márcio Galindo
authors.initials: MG
authors.lastname: Kiuchi
authors.forename: Ricardo Luiz Lima
authors.initials: RLL
authors.lastname: Andrade
authors.forename: Gustavo Ramalho da
authors.initials: GRD
authors.lastname: Silva
authors.forename: Hanry Barros
authors.initials: HB
authors.lastname: Souto
authors.forename: Shaojie
authors.initials: S
authors.lastname: Chen
authors.forename: Humberto Villacorta
authors.initials: HV
authors.lastname: Junior
mesh_terms: D000368:Aged; D002405:Catheterization, Central Venous / Q000379:methods*; D017147:Defibrillators, Implantable / Q000009:adverse effects*; D020878:Device Removal / Q000379:methods*; D004567:Electrodes, Implanted / Q000009:adverse effects*; D006801:Humans; D008297:Male; D010690:Phlebography / Q000379:methods; D013479:Superior Vena Cava Syndrome / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000601:surgery; D013927:Thrombosis / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D016896:Treatment Outcome; D014683:Vena Cava, Superior / Q000000981:diagnostic imaging