Starck Christoph Thomas, Caliskan Etem, Klein Holger, Steffel Jan, Falk Volkmar
Clinic of Cardiac and Vascular Surgery, University Hospital Zurich, Zurich, Switzerland.
Interact Cardiovasc Thorac Surg. 2014 May;18(5):551-5. doi: 10.1093/icvts/ivu005. Epub 2014 Feb 16.
In cases of challenging transvenous lead extraction procedures, limitations exist for the subclavian approach (SCA). In case of absent alternative approaches, the procedure may end with failure. Therefore, we investigated the femoral snare approach (FSA) as bailout procedure.
From December 2010 to August 2013, 114 patients with 190 leads were scheduled for transvenous lead extraction procedures [mean implant duration (MID): 74.7 (1-384) months]. In 28 leads [MID: 133.8 (36-384) months] the FSA was used. In 20 leads [MID: 127.5 (52-258) months] the FSA was performed as bailout approach and in 8 leads [MID: 149.6 (36-384) months] as first-line approach due to complete intravascular lead position.
In all FSA procedures (n = 28), clinical success was 85.7% and complete procedural success 64.3%. In FSA procedures as bailout approach (n = 20), clinical success was 80.0% and complete procedural success 55.0%. In first-line FSA procedures (n = 8), clinical success was 100.0% and complete procedural success 87.5%. Overall (n = 190) clinical success was 96.3%, complete procedural success 91.1%. By adding the FSA in cases of insufficient or impossible SCA, clinical success was increased by 12.6% (from 83.7 to 96.3%) and complete procedural success by 9.5% (from 81.6 to 91.1%). Comparison of leads extracted by SCA with leads extracted by FSA revealed that MID [133.8 (36-384) vs 64.4 (1-300) months; P < 0.0001] and the rate of passive fixation leads (67.9 vs 28.4%; P < 0.0001) were significantly higher in the FSA group.
In cases of failed or impossible subclavian approach, the femoral snare approach may improve overall success rates without relevantly increasing operative risk.
在具有挑战性的经静脉导线拔除手术中，锁骨下途径（SCA）存在局限性。若没有其他替代途径，手术可能以失败告终。因此，我们研究了股静脉圈套器途径（FSA）作为补救手术。
2010年12月至2013年8月，114例患者的190根导线计划进行经静脉导线拔除手术[平均植入时间（MID）：74.7（1 - 384）个月]。28根导线[MID：133.8（36 - 384）个月]使用了FSA。20根导线[MID：127.5（52 - 258）个月]的FSA作为补救途径进行，8根导线[MID：149.6（36 - 384）个月]因导线完全位于血管内作为一线途径进行FSA。
在所有FSA手术（n = 28）中，临床成功率为85.7%，手术完全成功率为64.3%。在作为补救途径的FSA手术（n = 20）中，临床成功率为80.0%，手术完全成功率为55.0%。在一线FSA手术（n = 8）中，临床成功率为100.0%，手术完全成功率为87.5%。总体（n = 190）临床成功率为96.3%，手术完全成功率为91.1%。在SCA不足或无法进行时增加FSA，临床成功率提高了12.6%（从83.7%提高到96.3%），手术完全成功率提高了9.5%（从81.6%提高到91.1%）。比较SCA拔除的导线与FSA拔除的导线发现，FSA组的MID[133.8（36 - 384）个月对64.4（1 - 300）个月；P < 0.0001]和被动固定导线的比例（67.9%对28.4%；P < 0.0001）显著更高。
在锁骨下途径失败或无法进行的情况下，股静脉圈套器途径可能提高总体成功率，而不会显著增加手术风险。
