Lead-Related Venous Obstruction in Patients With Implanted Cardiac Devices

Cardiac implantable electronic device implantation rates have increased in recent decades. Venous obstruction of the subclavian, brachiocephalic, or superior vena cava veins represents an important complication of implanted leads. These forms of venous obstruction can result in significant symptoms as well as present a barrier to the implantation of additional device leads. The risk factors for the development of these complications remain poorly understood, and diagnosis relies on clinical recognition and cross-sectional imaging. Anticoagulation remains the mainstay of treatment, and thrombus debulking, lead extraction, venoplasty, and stenting are all important therapeutic interventions. This review provides a multidisciplinary-based approach to the evaluation and management of cardiac implantable electronic device lead-associated venous obstruction. • Venous complications including obstruction occur in one-third of the nearly 1 million pacemakers and defibrillators implanted annually in the United States. • Beyond clinical recognition of this complication, characterization of the type and location by cross-sectional imaging, and anticoagulation, evolving strategies for management include debulking procedures and venoplasty with or without stenting. • More research is needed to determine the optimum timing of intervention in symptomatic patients, the role of interventions for asymptomatic venous complications, the duration of anticoagulation, and the roles of thrombectomy, thrombus debulking, and venous stenting.