Personal Technique and Experience: The Pisa Approach

Abstract

Technological advances in transvenous lead removal can be achieved by improving the materials and tools for lead extraction or modifying the techniques and approaches. I started the activity of transvenous lead removal in S. Chiara Hospital in Pisa, Italy, in December 1989; since then, with my coworkers, we have managed more than 2,500 pacing and implantable cardioverter-defibrillator (ICD) leads [1]. From the beginning, the technique and approaches have been continuously changed and improved, and by the beginning of 1997, we considered technique maturation to be complete [2]. From 1994 to 1996, we experienced the internal jugular approach to remove free-floating leads, and at the beginning of 1997, we started using it also in case of standard technique failure [3]. The first techniques I learned and applied for lead removal were traction with locking stylet, counter-pressure, and countertraction, as described by Byrd et al. [4], using polypropylene sheaths. Very often, we experienced the inability to insert the stylet up to the lead tip because of lead damage or stylet unlocking during traction; moreover, the force necessary to apply counterpressure and countertraction was discouraging.