Minimally Invasive Catheter Procedures to Assist Complicated Pacemaker Lead Extraction and Implantation in the Operating Room |
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Authors: | Patric Kr?pil Rotem S Lanzman Falk R Miese Dirk Blondin Joachim Winter Axel Scherer G??nter F??rst |
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Institution: | (1) Department of Radiology, University Hospital D?sseldorf, 40225 D?sseldorf, Germany;(2) Department of Cardiovascular Surgery, University Hospital D?sseldorf, Moorenstr. 5, 40225 D?sseldorf, Germany; |
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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. |
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