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

Journal Article · Fri Apr 15 00:00:00 EDT 2011 · Cardiovascular and Interventional Radiology

DOI:https://doi.org/10.1007/S00270-010-9887-X· OSTI ID:21608722

Kroepil, Patric; Miese, Falk R; Blondin, Dirk ^[1]; Winter, Joachim ^[2]; Scherer, Axel; Fuerst, Guenter ^[1]

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1. University Hospital Duesseldorf, Department of Radiology (Germany)
2. University Hospital Duesseldorf, Department of Cardiovascular Surgery (Germany)

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.

• OSTI ID: 21608722
• Journal Information: Cardiovascular and Interventional Radiology, Vol. 34, Issue 2; Other Information: DOI: 10.1007/s00270-010-9887-x; Copyright (c) 2011 Springer Science+Business Media, LLC and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE); Country of input: International Atomic Energy Agency (IAEA); ISSN 0174-1551
• Country of Publication: United States
• Language: English

Related Subjects

62 RADIOLOGY AND NUCLEAR MEDICINE
ADMINISTRATIVE PROCEDURES
BIOMEDICAL RADIOGRAPHY
CARDIAC PACEMAKERS
EXTRACTION
FEMALES
LEAD
MALES
MANUALS
PATIENTS
STANDARDS
VEINS
BLOOD VESSELS
BODY
CARDIOVASCULAR SYSTEM
DIAGNOSTIC TECHNIQUES
DOCUMENT TYPES
ELEMENTS
MEDICINE
METALS
NUCLEAR MEDICINE
ORGANS
RADIOLOGY
SEPARATION PROCESSES