Risk of venous occlusion after lead laser extraction preventing future lead implantation

Abstract

Background Lead laser extraction is a well-established method for removing unwanted leads with low morbidity and mortality. Objective In this observational study, we documented our experience with venous occlusion after lead laser extraction. Methods Retrospective data of patients who underwent lead laser extraction between May 2010 and August 2018 was analyzed. Two subgroups of patients were identified. First group represented patients after lead laser extraction who suffered postoperative venous occlusion. Second group represents patients after lead laser extraction, who has documented patent venous access after lead laser extraction. Results 219 patients underwent percutaneous laser lead extraction. The mean age of patients was 65 ± 14 years. Of these patients, 74% were male. The Most common indication for extraction was Nonfunctional lead (45.2%, n = 99) followed by pocket infection with 33.8% and endocarditis (17.3%). A total number of 447 leads underwent laser extraction. In 7.8% of the patients, lead extraction was partially successful and lead extraction was not successful in only 2.3% of the patients. Only 13 patients developed a documented venous occlusion postoperatively and 26 patients has documented absence of venous occlusion, of whom 17 were under oral anticoagulation. Conclusion Lead laser extraction may lead to venous occlusion, which is mostly asymptomatic but it prevents future lead implantation. The use of oral anticoagulant may prevent postoperative venous occlusion.

Superior vena cava syndrome and pacemaker leads. Explant by mechanical dissection system of extraction and percutaneous recanalization with stents for new device implantation

“…7). Premature anticoagulation should be considered in those patients with high risk of post-explant thrombosis (18); such as young patients under 30 years of age with long-lasting leads, multiple leads carriers or patients with partial venous system thrombosis, corroborated with venography before new implant. In our center, we also developed an action algorithm, which guides us in cases of superior vena cava syndrome and the removal of pacing/defibrillation leads (Table 2).…”

Discussing the Prognosis and Complications of Transvenous Lead Extraction in Patients With Cardiac Implantable Electronic Devices (CIED): A Systematic Review

“…Numerous risk factors, such as implanting the device on the right side, maintaining leads in place for longer than 10 years, removing three or more leads, and using the femoral approach during the procedure, may increase the likelihood of VA/T [ 33 ]. Contrarily, patients using anticoagulants demonstrated less occlusive consequences after laser lead extraction, as the laser can cause vascular abrasions, which can enhance the formation of clots and occlusion [ 34 ]. Using anticoagulants makes it easier and more successful for cardiologists to implant new CIEDs [ 34 ].…”

“…Contrarily, patients using anticoagulants demonstrated less occlusive consequences after laser lead extraction, as the laser can cause vascular abrasions, which can enhance the formation of clots and occlusion [ 34 ]. Using anticoagulants makes it easier and more successful for cardiologists to implant new CIEDs [ 34 ].…”

New Insights in Central Venous Disorders. The Role of Transvenous Lead Extractions

“…However, these data ( 28 , 29 ) reflect the experience of high-volume centers and suggest that the adoption of these strategies should be limited to experienced operators only. Finally, post-extraction venous occlusion and embolization of collateral veins have been described following TLE procedures using laser sheaths, because of vessel injuries promoting thrombus formation ( 43 ). The impact of this phenomenon is particularly relevant in case of TLEs performed for symptomatic venous obstructions and should be taken into account when defining the TLE strategy.…”