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 November 2011, we managed 1796 consecutive patients (1380 men, mean age 65.8 years, median 70, range 3-95) with 3226 leads (mean pacing period 69.8 months, range 1-420). PL were 2706 (1370 ventricular, 1109 atrial, 227 coronary sinus leads), DL were 520 (495 ventricular, 9 atrial, 16 superior vena cava leads). Indications to TLR were infection in 83% (systemic 27%, local 56%) 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 3218 leads because the technique was not applicable in 8 PL. Among these, 3160 leads (2642 PL and 518 DL) were completely removed (98.2%), 30 (0.9%) partially removed, 28 (0.9%) not removed. Among 3137 exposed leads, 487 were removed by manual traction (15.5%), 2357 by mechanical dilatation using the venous entry site (75.1%), 18 by femoral approach (FA) (0.6%) and 217 by JA (7%). All the free-floating leads were completely removed, 24.7% by FA and 75.3% by JA. Major complications occurred in 11 cases (0.61%): cardiac tamponade (10 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 defibrillating leads: the 1997-2011 single center experience
MG. Bongiorni;E. Soldati;L. Segreti;G. Zucchelli;A. Di Cori;L. Paperini;
2012-01-01
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 November 2011, we managed 1796 consecutive patients (1380 men, mean age 65.8 years, median 70, range 3-95) with 3226 leads (mean pacing period 69.8 months, range 1-420). PL were 2706 (1370 ventricular, 1109 atrial, 227 coronary sinus leads), DL were 520 (495 ventricular, 9 atrial, 16 superior vena cava leads). Indications to TLR were infection in 83% (systemic 27%, local 56%) 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 3218 leads because the technique was not applicable in 8 PL. Among these, 3160 leads (2642 PL and 518 DL) were completely removed (98.2%), 30 (0.9%) partially removed, 28 (0.9%) not removed. Among 3137 exposed leads, 487 were removed by manual traction (15.5%), 2357 by mechanical dilatation using the venous entry site (75.1%), 18 by femoral approach (FA) (0.6%) and 217 by JA (7%). All the free-floating leads were completely removed, 24.7% by FA and 75.3% by JA. Major complications occurred in 11 cases (0.61%): cardiac tamponade (10 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.
