Introduction
Upper extremity venous occlusion is a common complication encountered
after transvenous lead placement that presents either acutely or
chronically. Thrombus formation presents acutely with a painful, swollen
upper extremity. Treatment can include catheter directed thrombolytics
or anticoagulants/antiplatelet medications in an attempt to reduce
thrombus burden and allow time for collateral formation (1)(2). Patients
with acute symptoms that fail to resolve have undergone balloon dilation
or subsequent stenting even though both techniques are associated with
high rate of restenosis. Chronic lead related irritation of the venous
endothelium results in neointimal hyperplasia with fibrosis. In many
patients the lead related fibrosis eventually results in venous
obstruction. Patients typically remain asymptomatic, due to formation of
collateral circulation as fibrosis ensues (3) and the obstruction is
typically discovered at the time of lead addition or replacement. Those
who present with chronic symptoms presumably related to limited
collaterals are sometimes managed with balloon dilation although
symptoms quickly recur. The addition of stenting to balloon dilation has
similar results in jailing and potential damage to the leads. The
management of chronic lead related symptomatic venous obstruction is not
well established. Herein we discuss the addition a paclitaxel-coated
balloon (PCB) to high pressure balloon dilation as a potential way to
improve the results in chronic symptomatic lead related venous
obstruction