Difficult dual-stage transcutaneous multiple lead extraction with loss of external silicone tube of broken lead

Abstract

The extraction of three implanted (18-, 16-, and ten year-old) TEE-guided procedures. (Cardiol J 2013; 20, 1: 94-99)

Multiplane/3D transesophageal echocardiography monitoring to improve the safety and outcome of complex transvenous lead extractions

“…Cases have been described of remaining fragments of the silicone protective tube around the lead. These can easily be missed by fluoroscopy if no metallic fragment is retained . Echocardiography however is an ideal imaging tool in this clinical scenario, given the relatively high contrast between intracavitary blood and any type of solid foreign body.…”

Transesophageal echocardiography for the monitoring of transvenous lead extraction

“…In patients in whom TLE is performed for noninfectious indications connective tissue remnants do not affect long-term prognosis [39,45,46], but if TLE is performed for infectious reasons the remaining vegetations and/or fibrous 5 (potentially infected) is a risk factor for recurrent infection [42] and higher long-term mortality [47,48]. Fragments of insulation and lead segments >4 cm also have to be removed [1,27,30,31] (Fig. 4S-supplementary file).…”

“…Another important advantage of 2D and 3D TEE in patients undergoing TLE is a possibility of visualizing and monitoring percutaneous removal of silicone tube remnants left in cardiac cavities after TLE [16]. Insulation fragments remaining lodged in cardiac cavities are rarely described in the literature [18,27,31]. The silicone tube is invisible on fluoroscopy, that is why intraprocedural TEE is so important (Fig.…”

“…However, apart from the available guidelines, which are mainly expert consensus documents, there are only a few original and review papers on TEE as a monitoring tool in patients undergoing TLE[12][13][14][15][16][17][18][23][24][25]. Several case reports add valuable information to our medical knowledge[19,21,[26][27][28][29][30][31].• TLE monitoring steps with TEE TEE monitoring during TLE may be divided into four stages: preprocedural stage: from probe insertion to the start of lead dissection; stage two: navigation of lead removal; stage 3: postprocedural assessment of procedure efficacy with evaluation of possible damages, and additionally stage 4, during which TEE imaging is used for guidance of new lead placement. In the preprocedural stage we check lead position and course, identify intracardiac structures associated with leads (vegetations, clots, connective tissue bands), evaluate tricuspid valve function, presence of interatrial defects (PFO, ASD), left ventricular function (LVEF), and assess possible fluid accumulation in the pericardial and pleural space.…”

Incomplete Lead Removal During the Extraction Procedure: Predisposing Factors and Impact on Long-Term Survival in Infectious and Non-Infectious Cases: Analysis of 3741 Procedures

“…The goal of TLE is to remove all targeted leads in their entirety with a minimal risk of major complications [1][2][3]. Fracture of the lead during the removal procedure is not a rare complication (a few percent) [4][5][6][7][8][9][10][11], but only several papers [12][13][14] and case reports have addressed the strategy of lead fracture management [15][16][17][18][19]. Furthermore, little attention has been paid to the predictive role of incomplete lead extraction [20][21][22].…”