Regaining venous access for implantation of a new lead

Abstract

IntroductionVenous occlusion is a relatively common complication of endocardial lead implantation. It may cause a critical problem when implantation of a new lead is needed. Traditional methods result in leaving abandoned leads. The optimal approach seems to be the extraction of the damaged or abandoned lead, regaining venous access and implantation of a new lead.AimTo assess the efficacy and safety of new lead implantation by the method of lead extraction.Material and methodsAll transvenous lead extraction procedures (203 patients) between 1 August 2008 and 15 October 2012 were assessed. The analysis included cases with leads implanted for at least 6 months prior to extraction.ResultsRegaining venous access was the main indication for lead extraction in 5 patients (4.9%). The reason for new lead implantation was lead damage (n = 7) and system up-grade to cardiac resynchronization therapy (CRT) (n = 3). In total, 23 leads were extracted (9 defibrillation leads, 12 pacing leads and 2 left ventricular leads). The mean time from the implantation was 92.2 ±43.2 (48-152) months. In all cases Cook mechanical sheaths were applied. The use of the Evolution system was necessary to extract 3 leads. In all cases the new leads were successfully implanted as planned. No serious complications occurred.ConclusionsDiagnosis of venous occlusion should not be a contraindication for ipsilateral implantation of the new lead, because the techniques of transvenous lead extraction enable successful regaining of venous access.

The effectiveness of transvenous leads extractions implanted more than 10 years before

“…2) were used to separate the adhesions, which could not be overcome with polypropylene sheaths -the used methodology was described previously [1]. In 1 case the femoral approach with the Needle's Eye Snare -Cook Vascular (Leechburg, PA, USA) was used to extract the lead, which was broken during the attempted subclavian TLE [2].…”

One step behind to step ahead – femoral approach to stabilize and to extract functional pacing lead to regain venous access

“…The available data confirm the high effectiveness and safety of the technique [2, 6, 7, 9]. Some reports show a longer fluoro- and procedure time in femoral access [10], but sometimes it is the only solution.…”

“…The procedures of CIED therapy performed nowadays more and more often involve system upgrading and thus result in the necessity for implantation of new or additional leads [ 1 , 2 ]. An obstacle which may impede the procedure is subclavian vein occlusion.…”

“…One of them is lead extraction with the use of mixed subclavian and femoral access. Both methods are commonly used; the femoral approach is usually performed for unsuccessful subclavian TLE procedures, but some centers prefer it as a method of first choice [ 2 , 9 ].…”

“…Beside system infection, a rare, but clinically significant class I indication for TLE is regaining the venous access for the implantation of additional and/or new leads. This kind of indication accounts for about 2–5% of all TLE procedures performed currently in Polish sites [ 1 , 2 ]. The technique of two opposite venous vessels approach, with removal of the functioning lead, may be used in some individual cases.…”