Bongiorni Maria Grazia, Segreti Luca, Di Cori Andrea, Zucchelli Giulio, Viani Stefano, Paperini Luca, De Lucia Raffaele, Boem Adriano, Levorato Dianora, Soldati Ezio
Second Cardiology Division, Cardiothoracic and Vascular Department, University Hospital of Pisa, Pisa, Italy
Second Cardiology Division, Cardiothoracic and Vascular Department, University Hospital of Pisa, Pisa, Italy.
Europace. 2014 Sep;16(9):1356-62. doi: 10.1093/europace/euu004. Epub 2014 Apr 2.
We report our 15 years experience of a mechanical single-sheath technique with a multiple venous entry-site approach. We evaluated the effectiveness and safety of this technique in implantable defibrillator (ICD) lead extraction and investigated the potential association between clinical and lead-related factors and procedural complexity.
The proposed technique consists of an initial attempt at manual traction, followed by mechanical dilatation performed through the venous entry-site and, if necessary, by crossover to the internal transjugular approach. The study cohort comprised 545 consecutive patients referred to our institution for transvenous lead extraction from January 1997 to December 2012. Initial manual traction resulted in the effective removal of 6% of leads. Mechanical dilatation increased the success rate to 89% when performed through the venous entry-site, and to 99% when subsequently attempted via the internal jugular vein. No major complications were associated with lead extraction. Dwell-time, a passive fixation mechanism and dual-coil lead design were independently associated with the need for mechanical dilatation. However, dwell-time was the only variable associated with crossover to the internal transjugular approach. Specifically, a dwell-time of 20 months best predicted the need for venous entry-site mechanical dilatation, while a value of 55 months predicted crossover to the internal transjugular approach.
Mechanical transvenous extraction of ICD leads is a complex but safe and effective procedure. A longer lead dwell-time is associated with the need for mechanical dilatation and for crossover to the internal transjugular approach; this should be considered when planning the removal procedure. Moreover, passive lead fixation and dual-coil lead design predict a more challenging extraction procedure.
我们报告了采用多静脉入路单鞘技术的15年经验。我们评估了该技术在植入式心脏除颤器（ICD）导线拔除中的有效性和安全性，并研究了临床及导线相关因素与手术复杂性之间的潜在关联。
所提出的技术包括首先尝试手动牵引，随后通过静脉入路进行机械扩张，必要时转为经颈内静脉入路。研究队列包括1997年1月至2012年12月期间连续转诊至我院进行经静脉导线拔除的545例患者。最初的手动牵引有效拔除了6%的导线。通过静脉入路进行机械扩张时成功率提高到89%，随后尝试经颈内静脉进行机械扩张时成功率提高到99%。导线拔除未出现重大并发症。导线留置时间、被动固定机制和双线圈导线设计与需要进行机械扩张独立相关。然而，导线留置时间是与转为经颈内静脉入路唯一相关的变量。具体而言，20个月的留置时间最能预测需要进行静脉入路机械扩张，而55个月的值可预测转为经颈内静脉入路。
经静脉机械拔除ICD导线是一个复杂但安全有效的手术。较长的导线留置时间与需要进行机械扩张及转为经颈内静脉入路相关；在计划拔除手术时应考虑这一点。此外，被动导线固定和双线圈导线设计预示着拔除手术更具挑战性。
