The Bridge Occlusion Balloon as a Safety Net in High-Risk Transvenous Lead Extraction Procedures: A Novel Approach

Introduction: Injuries of the superior vena cava (SVC) during transvenous lead extraction (TLE) procedures are a rare, but life-threatening complication. The Bridge Occlusion Balloon (BOB) is specifically designed for temporary SVC occlusion in TLE procedures.

Case Presentation: We report the first case using the BOB as a safety net in a high-risk TLE procedure of a 27-years-old male. This patient, with a congenital corrected TGA and a third-degree AV- block was presenting with 4 dysfunctional pacemaker leads, (2 active fixation atrial leads, two active fixation ventricular leads; all with an exit block) venous stenosis and the necessity for a new pacemaker system. The leads were implanted for 12 and 19 years.

The BOB was placed with the proximal radiopaque marker at the cavoatrial junction and inflated. An angiography was performed to confirm right positioning of the balloon. With the deflated balloon in place, the TLE procedure with means of laser- and mechanical sheaths was conducted. Successful extraction of two dysfunctional leads, as well as venous recanalization for new RA and RV lead implantation was achieved. After the procedure, the balloon was checked for integrity, and no damage or leakage was present.

Conclusion: We have shown the feasibility to use powered extraction sheaths with a deflated BOB in place. In case of an SVC perforation, this allows for immediate balloon inflation, which safes time to stabilize the patients hemodynamic condition and reduces blood loss.