Kutarski Andrzej, Jacheć Wojciech, Pietura Radosław, Czajkowski Marek, Stefańczyk Paweł, Kosior Jarosław, Sawonik Sebastian, Nowosielecka Dorota
Department of Cardiology, University Hospital of Lublin, 20-059 Lublin, Poland.
2nd Department of Cardiology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 40-055 Katowice, Poland.
J Clin Med. 2025 Jan 6;14(1):282. doi: 10.3390/jcm14010282.
Removal of spontaneously fractured leads with their proximal ends migrated into the vascular space has not been analysed in detail thus far. The study aimed to compare the effectiveness of different approaches and auxiliary tools for removing fractured leads with migrated proximal ends. Retrospective analysis of 72 cases from a database containing 3847 TLEs (transvenous lead extraction). Most of the leads were passive, especially unipolar. Procedure complexity in such cases was high but with satisfying effectiveness (procedural success rate 93.06%) and independent of the position of the proximal end. The rate of major complications was 2.78%, which may be attributed to long implant duration (152.2 months). Extraction of such leads did not influence long-term survival. The femoral approach was most often used (62.50%). In 79.16% of leads, mechanical dissection was required. In 66.7%, proximal ends were strongly attached to the wall, and a loop had to be applied. In 15.28% of procedures, the lead was wrapped around a pig-tail catheter ("spaghetti twisting technique"). (1) Spontaneous lead fracture with the proximal ends migrated into the vascular space is a rare finding (1.87% of the TLE). (2) Removal of such leads requires the use of different approaches as well as dedicated and non-dedicated tools. (3) Despite a high level of procedure complexity, its effectiveness is high, with an acceptable rate of major complications.
迄今为止，对于近端已迁移至血管腔内的自发性断裂导线的取出尚未进行详细分析。本研究旨在比较不同方法和辅助工具对于取出近端迁移的断裂导线的有效性。对一个包含3847例经静脉导线取出术（TLE）的数据库中的72例病例进行回顾性分析。大多数导线为被动电极，尤其是单极电极。此类病例的手术复杂性较高，但有效性令人满意（手术成功率93.06%），且与近端位置无关。主要并发症发生率为2.78%，这可能归因于植入时间较长（152.2个月）。取出此类导线不影响长期生存率。最常采用股静脉入路（62.50%）。79.16%的导线需要进行机械分离。66.7%的病例中，近端与血管壁紧密粘连，必须应用圈套器。15.28%的手术中，导线缠绕在猪尾导管上（“意大利面条扭转技术”）。（1）近端迁移至血管腔内的自发性导线断裂是一种罕见情况（占TLE的1.87%）。（2）取出此类导线需要采用不同方法以及专用和非专用工具。（3）尽管手术复杂性较高，但其有效性较高，主要并发症发生率可接受。
