?url_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Adc&rft.title=The+Lead+Extractor's+Toolbox%3A+A+Review+Of+Current+Endovascular+Pacemaker+And+ICD+Lead+Extraction+Techniques%0A&rft.creator=Bracke%2C+FA&rft.subject=Indian+Pacing+and+Electrophysiology+Journal&rft.description=Recently+introduced+pacemaker+leads+float+freely+within+the+veins+and+myocardium.+Later+on%2C+fibrous+encapsulation+of+the+lead+develops+1.+These+adhesions+not+only+occur+at+the+lead+tip+but+are+commonly+found+anywhere+along+the+whole+length+of+the+lead+at+sites+where+the+lead+is+in+contact+with+the+vein+or+the+myocardium+1%2C2%2C3%2C4.+These+adhesions+hamper+lead+removal+as+tight+scar+tissue+can+withhold+the+leads+during+traction.+This+not+only+occurs+at+the+level+of+the+flings+and+tines+of+passive+fixation+leads+but+at+any+level+of+the+lead+body%2C+especially+at+sites+of+unequal+diameter+for+example+electrodes+and+defibrillator+coils.+Further+the+lead+tip+is+often+larger+than+the+lead+body+due+to+the+fixation+mechanism+and+adhering+scar+tissue+and+can+become+impacted+on+withdrawal+in+the+narrow+canal+provided+by+the+fibrous+envelope.%0A++++++++++++Force+applied+to+leads+is+limited+by+the+tensile+strength+of+the+insulation+and+conductor+coils+of+the+leads.+They+may+severe+with+forceful+traction%2C+and+denuded+indwelling+lead+fragments+have+a+higher+incidence+of+thrombo-fibrotic+complications+and+may+maintain+infection+5%2C6%2C7%2C8.+Force+is+also+limited+by+the+impact+of+traction+on+the+veins+and+myocardium.+Unopposed+traction+can+lead+to+invagination+of+the+myocardium%2C+myocardial+rupture%2C+arrhythmia%2C+hypotension+or+avulsion+of+a+tricuspid+valve+leaflet+9%2C10%2C11%2C12%2C13.%0A++++++++++++Therefore%2C+additional+tools+have+been+developed+to+assist+in+freeing+the+lead+body+from+the+adhesions+as+well+as+the+lead+tip+from+the+myocardium%2C+to+prevent+laceration+of+the+myocardium+and+to+provide+enough+room+for+the+lead+to+be+withdrawn+whilst+preventing+disintegration+of+the+lead.+We+describe+the+technical+aspects+of+current+endovascular+techniques%2C+the+results%2C+the+complications+and+shortly+discuss+the+indications.%0A&rft.publisher=Indian+Pacing+and+Electrophysiology+Group&rft.contributor=Singh%2C+Balbir&rft.contributor=Lokhandwala%2C+Yash&rft.contributor=Francis%2C+Johnson&rft.contributor=Gupta%2C+Anup&rft.date=2003-07&rft.type=Journal+(Paginated)&rft.type=PeerReviewed&rft.format=text%2Fhtml&rft.identifier=http%3A%2F%2Fcogprints.org%2F4258%2F1%2Fbracke.htm&rft.identifier=++Bracke%2C+FA++(2003)+The+Lead+Extractor's+Toolbox%3A+A+Review+Of+Current+Endovascular+Pacemaker+And+ICD+Lead+Extraction+Techniques.++%5BJournal+(Paginated)%5D+++++&rft.relation=http%3A%2F%2Fcogprints.org%2F4258%2F