The role of preoperative venography in predicting the difficulty of a transvenous lead extraction procedure

Abstract

Introduction:We hypothesized that an accurate assessment of preoperative venography could be useful in predicting transvenous lead extraction (TLE) difficulty. Methods and Results: A dedicated preoperative venogram was performed in consecutive patients with cardiac implantable electronic device who underwent TLE.The level of stenosis was classified as without significant stenosis, moderate, severe, and occlusion. The presence of extensive lead-venous wall adherence (≥50 mm) was also assessed. A total of 105 patients (median age: 71 years; 72% male) with a median of 2 (1-2) leads to extract were enrolled. Preoperative venography showed moderate to severe stenosis in 31 (30%), complete occlusion in 15 (14%), and extensive lead-venous wall adherence in 50 (48%) patients. Complete TLE success was achieved in 103 (98%) patients. A total of 55 (52%) were advanced extractions as they required a powered mechanical and/or laser sheath. They were more prevalent in the group with extensive lead-venous wall adherence (72% vs. 34%, p < .001), while no differences were found between patients with and without venous occlusion. In multivariate analysis, the presence of adherence was a predictor of advanced extraction (odds ratio: 2.89 [1.14-7.32], p = .025). The fluoroscopy time was also significantly longer (14.

Looking for lead adhesions while planning for transvenous lead extraction

“…The authors report that lead‐vein adherence was associated with higher TLE procedural complexity. Patients with extensive lead‐venous adherence required advanced tools in 72% of cases and fluoroscopy time was 14.0 min compared to 34.5% need for advanced tools ( p < .001) and mean fluoroscopy time of 5.1 min ( p < .001) in those without extensive adherence 6 . This association between lead‐venous adhesion and increased complexity of TLE mirrors what has been described for other imaging modalities.…”

“…While the difference in complications in patients with lead‐venous adherence in this study did not reach statistical significance, other studies support an association. In the study by Aboelhassan et al, lead dwell time and the number of leads were both positively associated with a higher likelihood of lead‐venous adherence, a finding supported by other studies as well 6,13 . These predictors of adherence are positively associated with the increase in the risk of TLE.…”

“…Venous stenosis was also assessed and classified as not significant (<50%), moderate (51%–70%), severe (71%–99%), and occlusive (100%). While the total number of leads was the only characteristic associated with occlusion, the total number of leads and the age of the oldest lead were both associated with lead‐venous adhesion 6 . The study may underestimate the prevalence of lead‐vein adherence and venous stenosis.…”

“…A dedicated preoperative ipsilateral venogram was performed in all patients assessed for the degree of venous stenosis and lead‐venous adherence. TLE was performed in a stepwise fashion in all patients, progressing from simple traction to nonpowered sheaths to powered sheaths (laser and mechanical) and finally, to snares via femoral access 6 …”

“…The authors a found similar need for advanced tools (53.3% vs. 52.2%, p > .9) and fluoroscopy times (10.7 vs. 8.0 min, p = .6) in those with and without venous occlusion. Furthermore, they report complete procedural success in 100% of subjects with total occlusion and 97.8% in those without ( p > .9) 6 . There are conflicting data on this point.…”