Mazzetti Hector, Cichero Carlos F, Tentori M Cristina, Mascheroni Osvaldo
Cardiology Division, Hospital Juan A. Fernández, Cerviño 3356, CP 1425 Buenos Aires, Argentina.
Europace. 2008 Feb;10(2):156-60. doi: 10.1093/europace/eum278.
The purpose of this manuscript is to describe a transjugular extraction technique which permits the use of locking stylets and sheaths, for leads previously cut and retracted into the venous system and/or damaged during an extraction performed via the superior approach.
A horizontal cervical incision is made over the sternocleidomastoid muscle to access the internal jugular vein between both fascicles of the muscle. The vein is ligated and through a phlebotomy a pig-tail catheter or the laparoscopic tool is introduced into the jugular vein. At the end of the procedure, a second ligature is also applied. This technique was utilized in 18 patients for the extraction of 22 leads with a mean implant duration of 91.8 months (range from 12 to 285 months). The age of the patients ranged from 19 to 87 years, (mean = 58.6 years). Out of the 22 leads extracted, 14 were ventricular pacemaker leads, 5 atrial pacemaker leads, 2 ICD leads, and 1 ventricular lead for VDD pacing. As regards the extractions, 18 were complete, 2 tips were abandoned (partial extractions), and 2 failed.
This technique is especially useful if the leads to be extracted were previously cut and had retracted into the central circulation. Although our experience is based only on 18 patients and 22 leads, we can conclude that the success rate we have achieved was high and the complication rate was very low.
本手稿旨在描述一种经颈静脉提取技术，该技术允许使用锁定导丝和护套，用于先前已切断并回缩至静脉系统和/或在经上腔途径进行的提取过程中受损的导线。
在胸锁乳突肌上方做一个水平颈部切口，以进入该肌肉两束之间的颈内静脉。结扎静脉，并通过静脉切开术将猪尾导管或腹腔镜工具引入颈静脉。在手术结束时，也进行第二次结扎。该技术用于18例患者提取22根导线，平均植入时间为91.8个月（范围为12至285个月）。患者年龄从19岁到87岁不等，（平均=58.6岁）。在提取的22根导线中，14根是心室起搏器导线，5根是心房起搏器导线，2根是植入式心脏除颤器导线，1根是用于VDD起搏的心室导线。关于提取情况，18例完整，2例尖端舍弃（部分提取），2例失败。
如果要提取的导线先前已切断并回缩至中心循环，该技术特别有用。尽管我们的经验仅基于18例患者和22根导线，但我们可以得出结论，我们所取得的成功率很高，并发症发生率非常低。
