Aboelhassan Mohamed, Bontempi Luca, Cerini Manuel, Salghetti Francesca, Arabia Gianmarco, Giacopelli Daniele, Fouad Doaa A, Abdelmegid Mohamed Aboel-Kassem F, Ahmed Tarek A N, Dell'Aquila Andrea, Curnis Antonio
Department of Cardiovascular Medicine, Assiut University Heart Hospital, Assiut University, Assiut, Egypt.
Department of Cardiology, Spedali Civili, Brescia, Italy.
J Cardiovasc Electrophysiol. 2022 May;33(5):1034-1040. doi: 10.1111/jce.15435. Epub 2022 Mar 14.
We hypothesized that an accurate assessment of preoperative venography could be useful in predicting transvenous lead extraction (TLE) difficulty.
A dedicated preoperative venogram was performed in consecutive patients with cardiac implantable electronic device who underwent TLE. The level of stenosis was classified as without significant stenosis, moderate, severe, and occlusion. The presence of extensive lead-venous wall adherence (≥50 mm) was also assessed. A total of 105 patients (median age: 71 years; 72% male) with a median of 2 (1-2) leads to extract were enrolled. Preoperative venography showed moderate to severe stenosis in 31 (30%), complete occlusion in 15 (14%), and extensive lead-venous wall adherence in 50 (48%) patients. Complete TLE success was achieved in 103 (98%) patients. A total of 55 (52%) were advanced extractions as they required a powered mechanical and/or laser sheath. They were more prevalent in the group with extensive lead-venous wall adherence (72% vs. 34%, p < .001), while no differences were found between patients with and without venous occlusion. In multivariate analysis, the presence of adherence was a predictor of advanced extraction (odds ratio: 2.89 [1.14-7.32], p = .025). The fluoroscopy time was also significantly longer (14.0 [8.2-18.7] vs. 5.1 [2.1-10.0] min, p < .001). The rate of complications did not differ based on the presence of venous lesions.
Although procedural success and complication rates were similar, patients with extensive lead-venous wall adherence required a longer fluoroscopy time and were three times more likely to need advanced extraction tools. Conversely, the presence of total venous occlusion had no impact on the procedure complexity.
我们假设术前静脉造影的准确评估可能有助于预测经静脉导线拔除（TLE）的难度。
对连续接受TLE的心脏植入式电子设备患者进行了专门的术前静脉造影。狭窄程度分为无明显狭窄、中度、重度和闭塞。还评估了是否存在广泛的导线-静脉壁粘连（≥50 mm）。共纳入105例患者（中位年龄：71岁；72%为男性），中位要拔除2（1 - 2）根导线。术前静脉造影显示31例（30%）患者有中度至重度狭窄，15例（14%）患者完全闭塞，50例（48%）患者有广泛的导线-静脉壁粘连。103例（98%）患者成功完成了TLE。共有55例（52%）患者进行了高级拔除，因为他们需要动力机械和/或激光鞘。这些情况在有广泛导线-静脉壁粘连的组中更常见（72%对34%，p < 0.001），而在有和没有静脉闭塞的患者之间未发现差异。多因素分析显示，粘连的存在是高级拔除的预测因素（比值比：2.89 [1.14 - 7.32]，p = 0.025）。透视时间也明显更长（14.0 [8.2 - 18.7]分钟对5.1 [2.1 - 10.0]分钟，p < 0.001）。并发症发生率不因静脉病变的存在而有所不同。
尽管手术成功率和并发症发生率相似，但有广泛导线-静脉壁粘连的患者需要更长的透视时间，并且需要高级拔除工具的可能性高出三倍。相反，完全静脉闭塞的存在对手术复杂性没有影响。
