Patel Nikhil, McDonald M Lawson, Bradford Natalie S, Smith Justin W, Beaty Elijah H, Rytlewski Jason A, Simmons Tony W, Whalen Patrick, Zhao David X, Bhave Prashant D
Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA.
Section on Cardiology, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA.
J Innov Card Rhythm Manag. 2018 Aug 15;9(8):3291-3296. doi: 10.19102/icrm.2018.090803. eCollection 2018 Aug.
As the number and complexity of cardiovascular implantable electronic devices has increased, so too has the incidence of device-related infections. Such a rise requires that the focus be directed toward developing universal standards for infected lead removal. To date, no consensus currently exists regarding the optimal management of patients with large vegetations (diameter > 2 cm). In these individuals, medical therapy is universally ineffective and they are often too ill for surgical extraction; furthermore, transvenous lead extraction (TLE) carries with it a risk of large septic pulmonary emboli. We present a series of five cases in which the AngioVac thrombectomy system (AngioDynamics Inc., Latham, NY, USA) was used as an adjunct to TLE. Debridement of infected leads prior to percutaneous lead extraction was accomplished as either a bridge to or as concomitant therapy with laser lead removal at our institution. This study included three males and two females with an average age of 52 years. The sizes of vegetations removed from leads ranged from 1.5 cm to 3.9 cm in the largest dimension and the average diameter was 2.65 cm ± 1.1 cm. The vegetations were successfully debulked in all five patients. This suggests that TLE performed with assistance from the AngioVac system (AngioDynamics Inc., Latham, NY, USA) is a safe and effective alternative to open surgical lead removal in patients with large lead vegetations.
随着心血管植入式电子设备的数量和复杂性不断增加，与设备相关的感染发生率也随之上升。这种上升要求将重点转向制定感染导线移除的通用标准。迄今为止，对于有大赘生物（直径>2 cm）患者的最佳管理尚无共识。在这些患者中，药物治疗普遍无效，而且他们往往病情过重无法进行手术摘除；此外，经静脉导线拔除术（TLE）存在发生大型感染性肺栓塞的风险。我们报告了一系列五例病例，其中使用AngioVac血栓切除术系统（美国纽约州拉瑟姆市的AngioDynamics公司）作为TLE的辅助手段。在我们机构，经皮导线拔除术前对感染导线进行清创，作为激光导线移除术的过渡或同期治疗。本研究包括三名男性和两名女性，平均年龄52岁。从导线上移除的赘生物最大尺寸在1.5 cm至3.9 cm之间，平均直径为2.65 cm±1.1 cm。所有五例患者的赘生物均成功减容。这表明，在有大导线赘生物的患者中，在AngioVac系统（美国纽约州拉瑟姆市的AngioDynamics公司）辅助下进行的TLE是开放性手术导线移除的一种安全有效的替代方法。
