Transvenous removal of pacing and implantable cardiac defibrillating leads using single sheath mechanical dilatation and multiple venous approaches: high success rate and safety in more than 2000 leads

Abstract

AimsThe aim of the present study was to describe a 10 years single-centre experience in pacing and defibrillating leads removal using an effective and safe modified mechanical dilatation technique.Methods and resultsWe developed a single mechanical dilating sheath extraction technique with multiple venous entry site approaches. We performed a venous entry site approach (VEA) in cases of exposed leads and an alternative transvenous femoral approach (TFA) combined with an internal transjugular approach (ITA) in the presence of very tight binding sites causing failure of VEA extraction or in cases of free-floating leads. We attempted to remove 2062 leads [1825 pacing and 237 implantable cardiac defibrillating (ICD) leads; 1989 exposed at the venous entry site and 73 free-floating] in 1193 consecutive patients. The VEA was effective in 1799 leads, the TFA in 28, and the ITA in 205; in the overall population, we completely removed 2032 leads (98.4%), partially removed 18 (0.9%), and failed to remove 12 leads (0.6%). Major complications were observed in eight patients (0.7%), causing three deaths (0.3%).ConclusionMechanical single sheath extraction technique with multiple venous entry site approaches is effective, safe, and with a good cost effective profile for pacing and ICD leads removal.

Sondenextraktionen eine anspruchsvolle Aufgabe

“…Schaut man sich die Literatur der letzten 20 Jahre an, so liegen die angegebenen Erfolgsraten bei 85% bis 100%. Wirft man einen Blick nur auf die letzten beiden Jahre, so werden in 95% bis 100% der Fälle erfolgreiche Sondenextraktionen berichtet [1,[10][11][12][13][14].…”

“…Ein Mittelwert aus mehreren Studien erbringt eine Mortalität von 0,4%. Der prozentuale Anteil an schwerwiegenden Komplikationen wird in der Literatur mit 0,3-7%, im Mittel mit 1,8% angegeben [1,9,[10][11][12][13][14].…”

Device Pocket Scar Predicts Transvenous Lead Extraction Difficulty

“…Reported major complication and mortality rates with TLE vary widely across studies, ranging from 0.4% to 7.3%. [3][4][5][6][7][8] The difficulty and risk of TLE of CIED is predominantly related to the body's foreign body response to the endovascular leads. The response begins immediately after implantation with thrombus development along the lead(s).…”

Broken leads with proximal endings in the cardiovascular system: Serious consequences and extraction diffi culties

“…A number of centers have described their experience in transvenous lead extraction (TLE), presenting encouraging results of low percentage of complications [4][5][6]. There are no descriptions of TLE procedures with free PLE migrated to the CVS, based on a larger population of patients with such a problem, except a few case reports [4,[7][8][9][10].…”

“…There are no descriptions of TLE procedures with free PLE migrated to the CVS, based on a larger population of patients with such a problem, except a few case reports [4,[7][8][9][10].…”