Department of Cardiology & Critical Care Medicine, Asklepios Klinik St. Georg, Hamburg, Germany.
Department of Cardiac Surgery, University Heart & Vascular Center Hamburg, University Hospital Eppendorf, Hamburg, Germany.
Heart Rhythm. 2021 Jun;18(6):970-976. doi: 10.1016/j.hrthm.2021.02.004. Epub 2021 Feb 9.
The number of patients requiring lead extraction has been increasing in recent years. Despite significant advances in operator experience and technique, unexpected complications may occur. Prophylactic placement of femoral sheaths allows for immediate endovascular access for emergency procedures and may shorten response time in the event of complications.
The purpose of this study was to assess the benefits of routine prophylactic femoral access in patients undergoing transvenous lead extraction (TLE) and to evaluate the methods, frequency, and efficacy of the emergency measures used in those patients.
We conducted a retrospective analysis of patients who underwent TLE from January 2012 to February 2019. The data were analyzed with regard to procedural complications and deployment of emergency measures via femoral access.
Two hundred eighty-five patients (mean age 65.3 ± 15.5 years) were included in the study. Median lead dwell time was 84 months (interquartile range 58-144). Overall complication rate was 4.2% (n = 12), with 1.8% major complications (n = 5). Clinical success rate was 97.2%. Procedure-related mortality was 1.1% (n = 3). Femoral sheaths were actively engaged in 9.1% (n = 26) of cases. Deployment of snares was the most common intervention (n = 10), followed by prophylactic (n = 6) or emergency placement (n = 1) of occlusion balloons, temporary pacing (n = 3), venous angioplasty (n = 3), diagnostic venography (n = 3), and extracorporeal membrane oxygenation (n = 1). We did not observe any femoral vascular complications due to prophylactic sheath placement.
Routine prophylactic placement of femoral sheaths shortens response time and quickly establishes control in the event of various complications that may occur during TLE procedures.
近年来，需要进行 Lead Extraction 的患者数量一直在增加。尽管术者经验和技术有了显著进步，但仍可能出现意外并发症。预防性放置股鞘可立即进行血管内介入治疗，并在发生并发症时缩短反应时间。
本研究旨在评估在接受经静脉 Lead Extraction（TLE）的患者中常规预防性股部入路的益处，并评估在这些患者中使用的紧急措施的方法、频率和效果。
我们对 2012 年 1 月至 2019 年 2 月期间接受 TLE 的患者进行了回顾性分析。分析了与手术并发症和通过股部入路部署紧急措施相关的数据。
本研究共纳入 285 例患者（平均年龄 65.3±15.5 岁）。中位 Lead 留置时间为 84 个月（四分位距 58-144）。总体并发症发生率为 4.2%（n=12），其中 1.8%为严重并发症（n=5）。临床成功率为 97.2%。与手术相关的死亡率为 1.1%（n=3）。股鞘在 9.1%（n=26）的病例中被积极使用。圈套器的使用最为常见（n=10），其次是预防性（n=6）或紧急（n=1）放置的封堵球囊、临时起搏（n=3）、静脉血管成形术（n=3）、诊断性静脉造影（n=3）和体外膜肺氧合（n=1）。我们没有观察到因预防性鞘管放置而导致的股血管并发症。
常规预防性放置股鞘可缩短反应时间，并在 TLE 手术中发生各种并发症时迅速控制局面。
