STENT DILATION OF SUPERIOR VENA-CAVA AND INNOMINATE VEIN OBSTRUCTIONSPERMITS TRANSVENOUS PACING LEAD IMPLANTATION

The purpose of this study was to assess the feasibility of stent dilat ion of venous obstructions/occlusions to permit transvenous pacing lea d implantation. Innominate vein or superior vena cava (SVC) obstructio n may preclude the implantation of transvenous pacing leads. Patients with d-transposition of the great arteries, after a Mustard or Senning procedure, and children with previously placed transvenous pacing lea ds are at higher risk for this vascular complication. From May 1993 to January 1996, eight pediatric patients who underwent transvenous paci ng lead implantation or replacement were found to have significant inn ominate vein or SVC obstruction or occlusion. Utilizing intravascular stents, a combined interventional and electrophysiological approach wa s used to relieve the venous obstruction and to permit implantation of a new transvenous pacing lead. Two patients had complete SVC occlusio n requiring puncture through the obstruction with a transseptal needle . Vessel recanalization was achieved with balloon dilation and stent i mplantation. The remaining six patients had severe venous obstruction with a mean minimum diameter of 3.1 +/- 3.3 mm. The mean pressure grad ient across the obstructed veins was 8.6 +/- 7.3 mmHg. Following impla ntation of 15 Palmaz P308 stents in eight vessels, the mean diameter i ncreased to 14.2 +/- 1.9 mm and the mean pressure gradient across the stented vessels decreased to 1.0 +/- 2.0 mmHg. A transvenous pacing le ad was implanted successfully through the stent(s) immediately or 6-8 weeks later. Innominate vein and SVC obstruction can be safely and eff ectively relieved with intravascular stents and permit immediate or su bsequent transvenous pacing lead implantation.