Li Xuebin, Ze Feng, Wang Long, Li Ding, Duan Jiangbo, Guo Fei, Yuan Cuizhen, Li Yuguang, Guo Jihong
Department of Cardiology, the First Affiliated Hospital of Shantou University Medical College, No. 22, Xinling Road, Shantou City, Guangdong, 515000, China Department of Cardiac Electrophysiology, Peking University People's Hospital, 11 Xizhimen South Street, Beijing, 100044, China.
Department of Cardiac Electrophysiology, Peking University People's Hospital, 11 Xizhimen South Street, Beijing, 100044, China Department of Cardiology, Key Laboratory of Molecular Cardiovascular Science, Ministry of Education, 11 Xizhimen South Street, Beijing, 100044, China.
Europace. 2014 Dec;16(12):1795-9. doi: 10.1093/europace/euu124. Epub 2014 Jun 19.
Data concerning the incidence of venous obstruction in patients referred for lead extraction is limited. Thus, we aimed to assess the incidence of venous obstruction in patients referred for lead extraction and the implications for tool selection.
Contrast venography of the access vein was obtained in 202 patients (147 men; mean age, 62.4 ± 14.5 years) scheduled for lead extraction. The indication for lead extraction included infection (n = 145, 72%) and other causes (n = 57, 28%). Two patients with device infection had superior vena caval occlusion. Access vein occlusion occurred in 6 (11%) patients without infection vs. 46 (32%) patients with infection [P = 0.002; odds ratio (OR) 3.94; 95% confidence interval (CI) 1.58-9.87]. No significant differences between occluded and non-occluded patients were seen for age, sex, device type, number of leads, time from implant of the initial lead, or anticoagulation therapy (all P>0.05). Procedural duration and fluoroscopy exposure time were significantly lower in the open group than in the occluded group (P < 0.05). Patients with venous occlusion required more advanced tools for lead extraction, such as dilator sheaths, evolution sheaths, and needle's eye snares (P = 0.019).
Both systemic and local infections are associated with increased risk of access vein occlusion. We found no support for the hypothesis that venous occlusion increases with the number of leads present. Lead extraction was more difficult in patients with venous occlusion, requiring advanced tools and more time.
关于因导线拔除而转诊患者的静脉阻塞发生率的数据有限。因此，我们旨在评估因导线拔除而转诊患者的静脉阻塞发生率及其对工具选择的影响。
对202例计划进行导线拔除的患者（147例男性；平均年龄62.4±14.5岁）进行了入路静脉造影。导线拔除的指征包括感染（n = 145，72%）和其他原因（n = 57，28%）。两名器械感染患者出现上腔静脉闭塞。未感染患者中有6例（11%）发生入路静脉闭塞，而感染患者中有46例（32%）发生入路静脉闭塞[P = 0.002；优势比（OR）3.94；95%置信区间（CI）1.58 - 9.87]。在年龄、性别、器械类型、导线数量、初始导线植入后的时间或抗凝治疗方面，闭塞患者和未闭塞患者之间无显著差异（所有P>0.05）。开放组的手术持续时间和透视暴露时间显著低于闭塞组（P < 0.05）。静脉闭塞患者需要更先进的导线拔除工具，如扩张鞘、进化鞘和针眼圈套器（P = 0.019）。
全身感染和局部感染均与入路静脉闭塞风险增加相关。我们没有找到支持静脉闭塞随现有导线数量增加而增加这一假设的证据。静脉闭塞患者的导线拔除更困难，需要先进的工具且耗时更长。
