Boczar Krzysztof, Sławuta Agnieszka, Ząbek Andrzej, Zyśko Dorota, Dębski Maciej, Gajek Jacek, Lelakowski Jacek, Małecka Barbara
Department of Electrocardiology, John Paul II Hospital, Kraków, Poland.
Department of Internal and Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, Poland.
Pol Merkur Lekarski. 2019 Aug 30;47(278):65-66.
A 65-year-old male patient underwent left-sided placement of implantable cardioverter-defibrillator. At three years after implantation he emerged complaining on left upper limb and left-sided neck edema. Left brachicephalic vein thrombosis due to device leads was recognized. The attending cardiologist referred the patient to university radiology department for venous angioplasty but the patient was admitted to cardiology department. Coronary angiography was performed due to suspicion of ischemic heart disease. However, it showed the presence of foreign body in cardiovascular system - completely intravascular round-tipped guide wire used in Seldinger technique for insertion of the endocardial lead abandoned in left subclavian vein and reaching to superior vena cava. Patient was transferred to third-degree reference lead extraction center. The procedure was performed under general anesthesia in hybrid operating room. Via femoral vein access we introduced Needle's Eye Snare and grasped the guide wire. Then, using polytetrafluoroethylene sheath the tissue adhesions were dissected and the complete guide wire was retrieved.
一名65岁男性患者接受了植入式心脏复律除颤器的左侧植入。植入三年后，他出现左上肢体和左侧颈部水肿的症状。经诊断为因设备导线导致的左头臂静脉血栓形成。主治心脏病专家将患者转诊至大学放射科进行静脉血管成形术，但患者被收治于心脏科。由于怀疑患有缺血性心脏病，进行了冠状动脉造影。然而，造影显示心血管系统中存在异物——在Seldinger技术中用于插入心内膜导线的完全血管内圆头导丝，该导丝被遗弃在左锁骨下静脉并延伸至上腔静脉。患者被转至三级参考导联拔除中心。该手术在杂交手术室全身麻醉下进行。通过股静脉通路，我们引入了针眼圈套器并抓住了导丝。然后，使用聚四氟乙烯鞘膜分离组织粘连，并取出了完整的导丝。
