Superior venous use of bridge balloon for percutaneous lead extraction in a patient with an interrupted inferior vena cava- case report

Background Transvenous lead extraction (TLE) is the gold-standard treatment for cardiac implantable electronic device (CIED) removal but carries a small risk of major complications, including superior vena cava (SVC) injury. The prompt use of endovascular occlusion devices can provide temporary haemostasis and haemodynamic stability in the rare event of SVC laceration. The presence of congenital heart disease and venous anomalies introduces additional technical complexity and necessitates careful procedural planning. Case summary A 52-year-old gentleman with dextrocardia and situs inversus totalis was referred to our centre for transvenous lead extraction after having presented with pacemaker pocket erosion. A CT venogram confirmed a completely interrupted inferior vena cava (IVC) with azygos continuation. A Bridge Balloon was pre-emptively placed via a superior venous approach through the right internal jugular vein as the IVC interruption precluded conventional approach through the femoral vein. TLE was performed under general anaesthesia using laser and mechanical sheaths, with successful extraction of all three leads and no major complications. The patient underwent reimplantation of a dual-chamber ICD on the right side after completing antibiotic therapy and was discharged in good condition. Discussion In IVC interruption, a superior approach for Bridge Balloon placement can provide effective protection against SVC injury. As survival of patients with congenital heart disease improves, awareness of anatomical variants and procedural adaptation is crucial for safe and successful lead extraction.