Purpose: Transvenous Pacing (PL) and Defibrillating Lead (DL) extraction is a highly effective technique. Device related complications are currently rising the need of Transvenous Lead Removal (TLR). Aim of this report is to analyse the longstanding experience performed in a single Italian center. Methods: since January 1997 to November 2008, 1365 consecutive patients (1023 men, mean age 65.5 years, range 3-95) with 2413 leads (mean pacing period 68.9 months, range 1-336) were managed. PL were 2101 (1146 ventricular, 843 atrial, 112 coronary sinus leads), DL were 312 (297 ventricular, 2 atrial, 13 superior vena cava leads). Indications to TLR were class I in 33% and class II in 67% of the leads. We performed mechanical dilatation using the Cook Vascular (Leechburg PA, USA) polypropylene sheaths and, if necessary, other intravascular tools (Catchers and Lassos, Osypka, Grentzig-Whylen, G); a Internal Trans-Jugular Approach (ITA) through the internal jugular vein was performed in case of free-floating leads or failure of standard approch. Results: Removal was attempted in 2409 leads because the technique was not applicable in 4 PL (0.2%); 2369 leads (2057 PL, all the 312 DL) were completely removed (98.2%), 20 (0.8%) partially removed, 20 (0.8%) not removed. Among 2329 exposed leads, 353 were removed by manual traction (15.1%), 1754 by mechanical dilatation using the venous entry site (75.3%), 14 by femoral approach (FA) (0.6%) and 168 by ITA (7.2%). All the 80 free-floating leads were completely removed, 23.7% by FA and 76.3% by ITA. Major complications occurred in 8 cases (0.58%): cardiac tamponade (7 cases, 2 deaths), hemotorax (1 death). Conclusions: our experience shows that TLR using mechanical dilation has a high success rate and a low incidence of serious complications in centers provided with wide experience. The use of the ITA allows a very high effectiveness and safety in case of free-floating or difficult exposed leads.
Transvenous removal of pacing and defibrillating leads using mechanical dilatation: a single center long term experience
MG. Bongiorni;E. Soldati;G. Zucchelli;A. Di Cori;Luca Segreti;G. Solarino;G. Coluccia
2009-01-01
Abstract
Purpose: Transvenous Pacing (PL) and Defibrillating Lead (DL) extraction is a highly effective technique. Device related complications are currently rising the need of Transvenous Lead Removal (TLR). Aim of this report is to analyse the longstanding experience performed in a single Italian center. Methods: since January 1997 to November 2008, 1365 consecutive patients (1023 men, mean age 65.5 years, range 3-95) with 2413 leads (mean pacing period 68.9 months, range 1-336) were managed. PL were 2101 (1146 ventricular, 843 atrial, 112 coronary sinus leads), DL were 312 (297 ventricular, 2 atrial, 13 superior vena cava leads). Indications to TLR were class I in 33% and class II in 67% of the leads. We performed mechanical dilatation using the Cook Vascular (Leechburg PA, USA) polypropylene sheaths and, if necessary, other intravascular tools (Catchers and Lassos, Osypka, Grentzig-Whylen, G); a Internal Trans-Jugular Approach (ITA) through the internal jugular vein was performed in case of free-floating leads or failure of standard approch. Results: Removal was attempted in 2409 leads because the technique was not applicable in 4 PL (0.2%); 2369 leads (2057 PL, all the 312 DL) were completely removed (98.2%), 20 (0.8%) partially removed, 20 (0.8%) not removed. Among 2329 exposed leads, 353 were removed by manual traction (15.1%), 1754 by mechanical dilatation using the venous entry site (75.3%), 14 by femoral approach (FA) (0.6%) and 168 by ITA (7.2%). All the 80 free-floating leads were completely removed, 23.7% by FA and 76.3% by ITA. Major complications occurred in 8 cases (0.58%): cardiac tamponade (7 cases, 2 deaths), hemotorax (1 death). Conclusions: our experience shows that TLR using mechanical dilation has a high success rate and a low incidence of serious complications in centers provided with wide experience. The use of the ITA allows a very high effectiveness and safety in case of free-floating or difficult exposed leads.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
