Buiten Maurits S, van der Heijden Aafke C, Schalij Martin J, van Erven Lieselot
Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
Europace. 2015 May;17(5):689-700. doi: 10.1093/europace/euu378. Epub 2015 Feb 16.
Currently several extraction tools are available in order to allow safe and successful transvenous lead extraction (TLE) of pacemaker and ICD leads; however, no directives exist to guide physicians in their choice of extraction tools and approaches. To aim of the current review is to provide an overview of the success and complication rates of different extraction methods and tools available. A comprehensive search of all published literature was conducted in the databases of PubMed, Embase, Web of Science, and Central. Included papers were original articles describing a specific method of TLE and the corresponding success rates of at least 50 patients. Fifty-three studies were included; the majority (56%) utilized 2 (1-4) different venous extraction approaches (subclavian and femoral), the median number of extraction tools used was 3 (1-6). A stepwise approach was utilized in the majority of the studies, starting with simple traction which resulted in successful TLE in 7-85% of the leads. When applicable the procedure was continued with non-powered tools resulting in a successful extraction of 34-87% leads. Subsequently, powered tools were applied whereby success rates further increased to 74-100%. The final step in TLE was usually utilized by femoral snare leading to an overall TLE success rate of 96-100%. The median procedure-related mortality and major complication described were, respectively, 0% (0-3%) and 1% (0-7%) per patient. In conclusion, a stepwise extraction approach can result in a clinical successful TLE in up to 100% of the leads with a relatively low risk of procedure-related mortality and complications.
目前有几种提取工具可用于安全、成功地经静脉拔除起搏器和植入式心脏转复除颤器（ICD）导线；然而，尚无指导医生选择提取工具和方法的指南。本次综述的目的是概述现有不同提取方法和工具的成功率及并发症发生率。我们在PubMed、Embase、Web of Science和Central数据库中对所有已发表的文献进行了全面检索。纳入的论文为描述特定经静脉导线拔除（TLE）方法及至少50例患者相应成功率的原创文章。共纳入53项研究；大多数研究（56%）采用了2种（1 - 4种）不同的静脉提取途径（锁骨下静脉和股静脉），使用的提取工具中位数为3种（1 - 6种）。大多数研究采用逐步方法，首先是简单牵引，7% - 85%的导线通过简单牵引成功实现TLE。如适用，接着使用非动力工具，34% - 87%的导线成功拔除。随后应用动力工具，成功率进一步提高到74% - 100%。TLE的最后一步通常是使用股静脉圈套器，总体TLE成功率为96% - 100%。所描述的与操作相关的死亡率和主要并发症的中位数分别为每位患者0%（0 - 3%）和1%（0 - 7%）。总之，逐步提取方法可使高达100%的导线临床成功实现TLE，且与操作相关的死亡率和并发症风险相对较低。
