Author/Editor		Kamenik, Borut; Pehnec, Zlatko; Sinkovič, Andreja
Title		Sindrom vene cave superior; redek zaplet trajne endokardialne elektrostimulacije srca
Translated title		Vena cava superior syndrome; a rare complication of permanent endocardial electrostimulation
Type		članek
Source		Zdrav Vestn
Vol. and No.		Letnik 68, št. 12
Publication year		1999
Volume		str. 727-30
Language		slo
Abstract		Background. Superior vena cava syndrome (SVCS) after permanent pacemaker implantation for transvenous cardiac pacing is a rare, but dangerous complication of this kind of treatment. Patients and methods. We have treated two patients in our group of 2235 implantations. The most important risk factors are: Damaged retained intravenous lead, infection, multiple surgical procedures on the pacing system. For obtaining the diagnosis radiological phlebography with digital subtraction is essential, because of thrombogenic effect of contrast media. Conclusions. The leading cause of 'SVCS is thrombosis, so the treatment consists of anticoagulant and fibrinolytic therapy as the basic treatment in consideration of higher bleeding risk in the head, upper thorax and upper limbs. In many cases the patients are without majorproblems although recanalisation of vena cava superior has not occur. For the extraction of infected leads in some cases surgical treatment is necessary. If stenosis remains after a successful fibrinolytic therapy, intraluminal balloon angioplasty is very successful.
Summary		Izhodišča. Sindrom obstrukcije vene cave superior (SVCS) po vsaditvi trajnega srčnega elektrostimulatorja za endokavitarno stimulacijo srca je redek, a težak zaplet tega načina zdravljenja. Bolniki in metode. Pri naših 2235 vsaditvah smo zabeležili dva takšna primera, ki ju prikazujemo v članku. Najpomembnejši so naslednji dejavniki ogrožanja: opuščen poškodovan elektrodni kateter, okužba, pogosti kirurški posegi na sistemu za elektrostimulacijo. V diagnostiki je najpomembnejša metoda flebografije z digitalno subtrakcijo, saj obstaja velika nevarnost trombogenega učinka kontrastnega sredstva. Zaključki. Vodilni vzrok SVCS je tromhoza.Osnova zdravljenja je antikoagulantna in fibrinolitična terapija, ob upoštevanju povečane nevarnosti krvavitev v področju glave, zgornjih udov in prsnega koša. Bolniki so pogosto brez težav kljub temu, da ne pride do rekanalizacije zgornje vene cave. Za adstranitev okuženih elektrodnih katetrov je potrebna kirurška terapija. Če po uspešni fibrinolitični terapiji ostane stenoza, je uspešna balonska dilatacija.
Descriptors		CARDIAC PACING, ARTIFICIAL SUPERIOR VENA CAVA SYNDROME PHLEBOGRAPHY ANTICOAGULANTS STREPTOKINASE