Key result
Lead extraction, venoplasty, and leadless pacing completely resolve CIED-induced chylous ascites.
Why the study?
CIED-related venous stenosis can impair thoracic duct outflow causing chylous effusions, but its role and treatment in chylous ascites after pacemaker implantation is not well characterized.
Does transvenous lead extraction and venoplasty resolve CIED-related venous obstruction causing chylous ascites?
Case Report (n=1)
Does transvenous lead extraction and venoplasty resolve CIED-related venous obstruction causing chylous ascites?
Transvenous lead extraction with venoplasty can restore lymphatic drainage and resolve chylous effusions secondary to CIED-induced central venous stenosis.
Answers are grounded in this paper and cite their sources.
Consider central venous stenosis in CIED patients with chylous effusions; single case leaves open optimal management.
BACKGROUND: Transvenous leads of cardiac implantable electronic devices (CIEDs) can cause central venous stenosis, impairing thoracic duct outflow, and result in chylous effusions. CASE SUMMARY: A 48-year-old man developed refractory chylous ascites/chylothorax after pacemaker implantation. Magnetic resonance lymphangiography demonstrated thoracic duct dilatation and mesenteric reflux secondary to venous stenosis. Thoracic duct thrombolysis provided only temporary improvement. Transvenous lead extraction, balloon venoplasty, and leadless pacemaker implantation resulted in complete resolution. DISCUSSION: CIED-related venous obstruction can cause lymphatic hypertension with chylous ascites/chylothorax by impairing thoracic duct drainage. Unlike direct thoracic duct injury, venous obstruction disrupts lymphatic outflow rather than causing immediate leakage. Definitive treatment requires relief of the venous obstruction. Lead extraction with venoplasty restores lymphatic drainage, whereas leadless pacing avoids further transvenous venous injury. TAKE-HOME MESSAGES: CIED-related venous stenosis should be considered in patients with unexplained chylous effusions. Lead extraction with venoplasty can restore lymphatic drainage, and leadless pacing is an effective alternative.
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Kaur et al. (2026) conducted a case report in Refractory chylous ascites/chylothorax after pacemaker implantation (n=1). Transvenous lead extraction, balloon venoplasty, and leadless pacemaker implantation was evaluated on Resolution of chylous ascites/chylothorax. Transvenous lead extraction, balloon venoplasty, and leadless pacemaker implantation resulted in complete resolution of chylous ascites caused by CIED-related venous stenosis.
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