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. 2008 Dec;29(23):2886-93.
doi: 10.1093/eurheartj/ehn461. Epub 2008 Oct 23.

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

Maria Grazia Bongiorni  1 , Ezio Soldati, Giulio Zucchelli, Andrea Di Cori, Luca Segreti, Raffaele De Lucia, Gianluca Solarino, Alberto Balbarini, Mario Marzilli, Mario Mariani
Affiliations

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

Maria Grazia Bongiorni et al. Eur Heart J. 2008 Dec.

Abstract

Aims: The 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 results: We 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%).

Conclusion: Mechanical 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.

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Figures

Figure 1
Figure 1
Consecutive steps of the internal transjugular approach (ITA) in case of crossover from the venous entry approach (VEA). (A) A tip deflecting wire is advanced via the femoral vein in order to assess the possibility to grasp the lead and to move it. (B) Once the lead has been grasped, it is pulled down in the inferior vena cava and slipped through the binding site; a Lasso, introduced through the internal jugular vein, is advanced near the proximal end of the lead. (C) The lead is caught by the Lasso, pulled up and exposed through the jugular vein. (D) Dilatation using a dilating sheath is performed. See the text for further details. TDW, tip deflecting wire.
Figure 2
Figure 2
Consecutive steps of the internal transjugular approach (ITA) in case of free-floating leads with anchored tips. (A) A tip deflecting wire is advanced via the femoral vein in order to assess the possibility to grasp the lead and to move it. (B) Once the lead has been grasped, it is pulled down in the inferior vena cava; a Lasso, introduced through the internal jugular vein, is advanced near the proximal end of the lead. (C) The lead is caught by the lasso and then pulled up and exposed through the jugular vein. (D) Dilatation using a dilating sheath is performed. See the text for further details. TDW, tip deflecting wire; FF, free-floating lead.
Figure 3
Figure 3
Diagram summarizing the outcome of the overall leads included in the study, their management, and the final result. ISR, incremental success rate; NA, not applicable; VEA, venous entry approach; VES, venous entry site.
See this image and copyright information in PMC

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