Department of Internal Medicine, Division of Cardiovascular Medicine, University of Nebraska Medical Center, Omaha, NE, USA.
Department of Surgery, Division of Cardiothoracic Surgery, University of Nebraska Medical Center, Omaha, NE, USA.
Am J Case Rep. 2021 Oct 22;22:e932073. doi: 10.12659/AJCR.932073.
BACKGROUND Percutaneous transvenous lead extraction (TLE) of cardiac implantable electronic devices can be performed with a high success rate. However, TLE has its limitations and challenges. Recognizing the challenges at an early stage during the procedure is vital for appropriate patient management. We present a challenging case of implantable cardioverter-defibrillator (ICD) lead extraction in which we aborted TLE in favor of elective surgical extraction (SE). This potentially prevented a major catastrophic complication of vascular tear, which would have required an emergent thoracotomy. CASE REPORT A 37-year-old woman with history of hypertrophic cardiomyopathy had a primary prevention dual-chamber ICD implant in 2001 and underwent right ventricular ICD lead revision in 2009 due to lead fracture. In 2019, she was again found to have right ventricular ICD lead malfunction. TLE was attempted, but no meaningful progression could be made despite using multiple extraction tools. Therefore, TLE was aborted in favor of SE. During elective SE, significant adhesions were noted, and the innominate vein was completely avulsed during removal of the leads, requiring venous reconstruction by the vascular surgery team. After SE and vascular reconstruction, an epicardial ICD system was placed, and the patient had an uneventful postoperative recovery. CONCLUSIONS This case report highlights the limitations of TLE and the importance of recognizing them in a timely manner. In all challenging cases, conversion to elective SE should be considered to avoid potential injuries warranting emergent surgical repair.
经皮经腔心脏植入式电子设备（CIED）的静脉内导线拔除术（TLE）可以达到很高的成功率。然而，TLE 存在其局限性和挑战。在手术过程中尽早识别这些挑战对于患者的适当管理至关重要。我们提出了一个具有挑战性的心脏复律除颤器（ICD）导线拔除病例，我们选择了择期外科提取（SE）而非 TLE。这可能避免了血管撕裂这一重大灾难性并发症，否则需要紧急开胸手术。
一名 37 岁女性，有肥厚型心肌病病史，2001 年植入了原发性预防双腔 ICD，2009 年因导线断裂而进行了右心室 ICD 导线修订。2019 年，她再次发现右心室 ICD 导线功能异常。尝试了 TLE，但尽管使用了多种提取工具，仍无法取得明显进展。因此，TLE 被放弃，转而选择 SE。在择期 SE 期间，发现存在明显的粘连，在取出导线时无名静脉完全撕裂，需要血管外科团队进行静脉重建。SE 和血管重建后，放置了心外膜 ICD 系统，患者术后恢复顺利。
本病例报告强调了 TLE 的局限性以及及时识别这些局限性的重要性。在所有具有挑战性的病例中，应考虑转换为择期 SE，以避免潜在的损伤，需要紧急手术修复。
