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CardioVascular and Interventional Radiology

, Volume 34, Issue 2, pp 345–351 | Cite as

Minimally Invasive Catheter Procedures to Assist Complicated Pacemaker Lead Extraction and Implantation in the Operating Room

  • Patric Kröpil
  • Rotem S. LanzmanEmail author
  • Falk R. Miese
  • Dirk Blondin
  • Joachim Winter
  • Axel Scherer
  • Günter Fürst
Clinical Investigation
  • 118 Downloads

Abstract

We report on percutaneous catheter procedures in the operating room (OR) to assist complicated manual extraction or insertion of pacemaker (PM) and implantable cardioverter defibrillator leads. We retrospectively reviewed complicated PM revisions and implantations performed between 2004 and 2009 that required percutaneous catheter procedures performed in the OR. The type of interventional procedure, catheter and retrieval system used, venous access, success rates, and procedural complications were analyzed. In 41 (12 female and 29 male [mean age 62 ± 17 years]) of 3021 (1.4%) patients, standard manual retrieval of old leads or insertion of new leads was not achievable and thus required percutaneous catheter intervention for retrieval of misplaced leads and/or recanalisation of occluded central veins. Thirteen of 18 (72.2%) catheter-guided retrieval procedures for misplaced (right atrium [RA] or ventricle [RV; n = 3], superior vena cava [n = 2], brachiocephalic vein [n = 5], and subclavian vein [n = 3]) lead fragments in 16 patients were successful. Percutaneous catheter retrieval failed in five patients because there were extremely fixed or adhered lead fragments. Percutaneous transluminal angiography (PTA) of central veins for occlusion or high-grade stenosis was performed in 25 patients. In 22 of 25 patients (88%), recanalization of central veins was successful, thus enabling subsequent lead replacement. Major periprocedural complications were not observed. In the case of complicated manual PM lead implantation or revision, percutaneous catheter-guided extraction of misplaced lead fragments or recanalisation of central veins can be performed safely in the OR, thus enabling subsequent implantation or revision of PM systems in the majority of patients.

Keywords

Interventional radiology Pacemaker lead PTA Extraction Retrieval device 

References

  1. 1.
    Stoney WS, Addlestone RB, Alford WC Jr, Burrus GR, Frist RA, Thomas CS Jr (1976) The incidence of venous thrombosis following long-term transvenous pacing. Ann Thorac Surg 22:166–170CrossRefPubMedGoogle Scholar
  2. 2.
    Uflacker R, Lima S, Melichar AC (1986) Intravascular foreign bodies: percutaneous retrieval. Radiology 160:731–735PubMedGoogle Scholar
  3. 3.
    Myers MR, Parsonnet V, Bernstein AD (1991) Extraction of implanted transvenous pacing leads: a review of a persistent clinical problem. Am Heart J 121:881–888CrossRefPubMedGoogle Scholar
  4. 4.
    Egglin TK, Dickey KW, Rosenblatt M, Pollak JS (1995) Retrieval of intravascular foreign bodies: experience in 32 cases. AJR Am J Roentgenol 164:1259–1264PubMedGoogle Scholar
  5. 5.
    Dotter CT, Rosch J, Bilbao MK (1971) Transluminal extraction of catheter and guide fragments from the heart and great vessels: 29 collected cases. AJR Am J Roentgenol 111:467–472Google Scholar
  6. 6.
    Gabelmann A, Kramer S, Gorich J (2001) Percutaneous retrieval of lost or misplaced intravascular objects. AJR Am J Roentgenol 176:1509–1513PubMedGoogle Scholar
  7. 7.
    Nemcek AA Jr, Vogelzang RL (1987) Modified use of the tip-deflecting wire in manipulation of foreign bodies. AJR Am J Roentgenol 149:777–779PubMedGoogle Scholar
  8. 8.
    Cekirge S, Weiss JP, Foster RG, Neiman HL, McLean GK (1993) Percutaneous retrieval of foreign bodies: experience with the nitinol goose neck snare. J Vasc Interv Radiol 4:805–810CrossRefPubMedGoogle Scholar
  9. 9.
    Byrd CL, Schwartz SJ, Hedin N (1991) Intravascular techniques for extraction of permanent pacemaker leads. J Thorac Cardiovasc Surg 101:989–997PubMedGoogle Scholar
  10. 10.
    Leoni CJ, Potter JE, Rosen MP et al (2001) Classifying complications of interventional procedures: a survey of practicing radiologists. J Vasc Interv Radiol 12:55–59CrossRefPubMedGoogle Scholar
  11. 11.
    Scott PA, Chow W, Ellis E, Morgan JM, Roberts PR (2009) Extraction of pacemaker and implantable cardioverter defibrillator leads: a single-centre study of electrosurgical and laser extraction. Europace 11:1501–1504CrossRefPubMedGoogle Scholar
  12. 12.
    Calvagna GM, Evola R, Scardace G, Valsecchi S, Calvagna GM, Evola R et al (2009) Single-operator experience with a mechanical approach for removal of pacing and implantable defibrillator leads. Europace 11:1505–1509Google Scholar
  13. 13.
    Kennergren C, Bjurman C, Wiklund R, Gäbel J (2009) A single-centre experience of over one thousand lead extractions. Europace 11:612–617CrossRefPubMedGoogle Scholar
  14. 14.
    Rozmus G, Daubert JP, Huang DT, Rosero S, Hall B, Francis C (2005) Venous thrombosis and stenosis after implantation of pacemakers and defibrillators. J Interv Card Electrophysiol 13:9–19CrossRefPubMedGoogle Scholar
  15. 15.
    Doering RB, Stemmer EA, Connolly JE (1967) Complications of indwelling venous catheters with particular reference to catheter embolus. Am J Surg 114:259–266CrossRefPubMedGoogle Scholar
  16. 16.
    Smith MC, Love CJ (2008) Extraction of transvenous pacing and ICD leads. Pacing Clin Electrophysiol 31:736–752CrossRefPubMedGoogle Scholar
  17. 17.
    Wolf F, Schernthaner RE, Dirisamer A, Schoder M, Funovics M, Kettenbach J et al (2008) Endovascular management of lost or misplaced intravascular objects: experiences of 12 years. Cardiovasc Intervent Radiol 31:563–568CrossRefPubMedGoogle Scholar
  18. 18.
    Spittell PC, Vlietstra RE, Hayes DL, Higano ST (1990) Venous obstruction due to permanent transvenous pacemaker electrodes: treatment with percutaneous transluminal balloon venoplasty. Pacing Clin Electrophysiol 13:271–274CrossRefPubMedGoogle Scholar
  19. 19.
    Montgomery JH, D’Souza VJ, Dyer RB, Formanek AG, Prabhu SH (1985) Nonsurgical treatment of the superior vena cava syndrome. Am J Cardiol 56:829–830CrossRefPubMedGoogle Scholar
  20. 20.
    Chan AW, Bhatt DL, Wilkoff BL, Roffi M, Mukherjee D, Gray BH et al Percutaneous treatment for pacemaker-associated superior vena cava syndrome. Pacing Clin Electrophysiol 25:1628–1633Google Scholar
  21. 21.
    Yedlicka JW Jr, Carson JE, Hunter DW, Castaneda-Zuniga WR, Amplatz K (1991) Nitinol gooseneck snare for removal of foreign bodies: experimental study and clinical evaluation. Radiology 178:691–693PubMedGoogle Scholar
  22. 22.
    Mickley V, Gorich J, Rilinger N, Storck M, Abendroth D (1997) Stenting of central venous stenoses in hemodialysis patients: long-term results. Kidney Int 51:277–280CrossRefPubMedGoogle Scholar
  23. 23.
    Kalman PG, Lindsay TF, Clarke K, Sniderman KW, Vanderburgh L (1998) Management of upper extremity central venous obstruction using interventional radiology. Ann Vasc Surg 12:202–206CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2010

Authors and Affiliations

  • Patric Kröpil
    • 1
  • Rotem S. Lanzman
    • 1
    Email author
  • Falk R. Miese
    • 1
  • Dirk Blondin
    • 1
  • Joachim Winter
    • 2
  • Axel Scherer
    • 1
  • Günter Fürst
    • 1
  1. 1.Department of RadiologyUniversity Hospital DüsseldorfDüsseldorfGermany
  2. 2.Department of Cardiovascular SurgeryUniversity Hospital DüsseldorfDüsseldorfGermany

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