Why the study?
Superior vena cava stenosis or obstruction post transvenous cardiac device insertion is particularly challenging during lead revision or device upgrade.
Percutaneous reconstruction of a de novo SVC/right atrium conduit may be a viable approach for CRT upgrade in patients with complex SVC obstruction.
Hypothesis-generating for percutaneous SVC conduit reconstruction in CRT upgrade; prospective studies needed before adoption.
Superior vena cava (SVC) stenosis and obstruction post transvenous cardiac device insertion has been widely documented.1–3 It becomes particularly challenging in the setting of lead revision or device upgrade.4 Management options include SVC venoplasty, thrombus debulking, and anticoagulation.3,5–7 In complex cases, however, lead extractions, surgical bypass with reconstruction of SVC,8 or alternative devices not requiring venous access9 may be considered. We present an interesting case of approaching SVC obstruction by percutaneous reconstruction of a de novo conduit to facilitate cardiac resynchronization therapy (CRT) upgrade.
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Rathore et al. (2024) studied this question.
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