Background: Percutaneous removal of implantable defibrillator (ICD) leads remains a difficult procedure, despite the fact that extraction techniques have been improved and advances in lead technology have been made in order to reduce fibrous tissue growth along the lead, thereby easing extraction. We evaluated the effectiveness and safety of a mechanical single-sheath extraction technique, described the occurrence and location of fibrous adherences detected during the procedure, and investigated the relationship between the presence of adherences and patient and lead characteristics. Methods and Results: We studied 545 consecutive patients who underwent transvenous extraction of 582 ICD leads from 1997 to 2012. Our technique achieved a success rate of 99%, causing no major complications. Fibrotic adherences were found during removal of 547 leads requiring mechanical dilatation. Areas of adherence were in the subclavian vein (78%), the innominate vein (64%), the superior vena cava (65%) and the heart (73%). Dwell-time, passive fixation and dual-coil lead design were independently associated with adherences. Dual-coil lead design was associated with adherences in the innominate vein and in the superior vena cava, coil treatment (expandable polytetrafluoroethylene-coated or medical adhesive back-filled coils) prevented adherences in the superior vena cava, and the passive fixation mechanism was associated with adherences in the heart. Conclusions: Mechanical single-sheath extraction of ICD leads proved safe and effective. The presence of fibrotic adhesions was frequently associated with longer lead dwell-time, passive fixation and dual-coil lead design. By contrast, the use of treated coils prevented intravenous adherences.
Impact of coils and fixation mechanism on implantable cardioverter defibrillator lead extraction
L. Segreti;MG. Bongiorni;A. Di Cori;G. Zucchelli;L. Paperini;G. Coluccia;SL. Romano;
2014-01-01
Abstract
Background: Percutaneous removal of implantable defibrillator (ICD) leads remains a difficult procedure, despite the fact that extraction techniques have been improved and advances in lead technology have been made in order to reduce fibrous tissue growth along the lead, thereby easing extraction. We evaluated the effectiveness and safety of a mechanical single-sheath extraction technique, described the occurrence and location of fibrous adherences detected during the procedure, and investigated the relationship between the presence of adherences and patient and lead characteristics. Methods and Results: We studied 545 consecutive patients who underwent transvenous extraction of 582 ICD leads from 1997 to 2012. Our technique achieved a success rate of 99%, causing no major complications. Fibrotic adherences were found during removal of 547 leads requiring mechanical dilatation. Areas of adherence were in the subclavian vein (78%), the innominate vein (64%), the superior vena cava (65%) and the heart (73%). Dwell-time, passive fixation and dual-coil lead design were independently associated with adherences. Dual-coil lead design was associated with adherences in the innominate vein and in the superior vena cava, coil treatment (expandable polytetrafluoroethylene-coated or medical adhesive back-filled coils) prevented adherences in the superior vena cava, and the passive fixation mechanism was associated with adherences in the heart. Conclusions: Mechanical single-sheath extraction of ICD leads proved safe and effective. The presence of fibrotic adhesions was frequently associated with longer lead dwell-time, passive fixation and dual-coil lead design. By contrast, the use of treated coils prevented intravenous adherences.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
