Introduction: Transvenous extraction of Pacing (PL) and Defibrillating Leads (DL) is today 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 December 2010, we managed 1627 consecutive patients (1238 men, mean age 65.7 years, range 3-95) with 2914 leads (mean pacing period 70.2 months, range 1-420). PL were 2485 (1303 ventricular, 1011 atrial, 171 coronary sinus leads), DL were 429 (409 ventricular, 6 atrial, 14 superior vena cava leads). Indications to TLR were sepsis in in 28%, local infection in 55% and noninfectice indication in 17% 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 (JA) through the internal jugular vein was performed in case of free-floating leads or failure of standard approach. Results: Removal was attempted in 2906 leads because the technique was not applicable in 8 PL. Among these, 2852 leads (2423 PL, all the 429 DL) were completely removed (98.1%), 29 (1%) partially removed, 25 (0.9%) not removed. Among 2825 exposed leads, 434 were removed by manual traction (15.4%), 2117 by mechanical dilatation using the venous entry site (74.9%), 15 by femoral approach (FA) (0.5%) and 205 by JA (7.2%). All the free-floating leads were completely removed, 24.7% by FA and 75.3% by JA. Major complications occurred in 10 cases (0.61%): cardiac tamponade (9 cases, 2 deaths), hemotorax (1 death). Conclusions: our experience shows that in centers provided with wide experience, TLR using mechanical dilation has a high success rate and a low incidence of serious complications. The use of the JA allows a very high effectiveness and safety in case of free-floating or difficult exposed leads.
Transvenous removal of pacing and implantable cardiac defibrillating leads using single sheath mechanical dilatation and multiple venous approaches: the Pisa experience
MG. Bongiorni;E. Soldati;G. Zucchelli;L. Segreti;A. Di Cori;L. Paperini;
2011-01-01
Abstract
Introduction: Transvenous extraction of Pacing (PL) and Defibrillating Leads (DL) is today 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 December 2010, we managed 1627 consecutive patients (1238 men, mean age 65.7 years, range 3-95) with 2914 leads (mean pacing period 70.2 months, range 1-420). PL were 2485 (1303 ventricular, 1011 atrial, 171 coronary sinus leads), DL were 429 (409 ventricular, 6 atrial, 14 superior vena cava leads). Indications to TLR were sepsis in in 28%, local infection in 55% and noninfectice indication in 17% 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 (JA) through the internal jugular vein was performed in case of free-floating leads or failure of standard approach. Results: Removal was attempted in 2906 leads because the technique was not applicable in 8 PL. Among these, 2852 leads (2423 PL, all the 429 DL) were completely removed (98.1%), 29 (1%) partially removed, 25 (0.9%) not removed. Among 2825 exposed leads, 434 were removed by manual traction (15.4%), 2117 by mechanical dilatation using the venous entry site (74.9%), 15 by femoral approach (FA) (0.5%) and 205 by JA (7.2%). All the free-floating leads were completely removed, 24.7% by FA and 75.3% by JA. Major complications occurred in 10 cases (0.61%): cardiac tamponade (9 cases, 2 deaths), hemotorax (1 death). Conclusions: our experience shows that in centers provided with wide experience, TLR using mechanical dilation has a high success rate and a low incidence of serious complications. The use of the JA 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.
