?url_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Adc&rft.title=Reuse+of+Occluded+Veins+During+Permanent+Pacemaker+Lead+Extraction%3A+A+New+Indication+for+Femoral+Lead+Extraction+&rft.creator=Staniforth%2C+Andrew+D&rft.creator=Schilling%2C+Richard+J&rft.subject=Indian+Pacing+and+Electrophysiology+Journal&rft.description=Objectives%3A+This+study+examined+the+utility+of+a+novel+technique+for+reuse+of+thrombosed+veins+when+extracting+permanent+pacemaker+leads+via+a+femoral+vein+approach.%0ABackground%3A+Although+lead+extraction+permanent+pacemaker+using+a+femoral+approach+has+advantages+over+the+subclavian+approach%2C+it+cannot+be+used+to+provide+access+for+a+new+lead+using+currently+employed+techniques.+This+is+important+because+up+to+23%25+of+patients+have+occluded+veins+after+permanent+pacemaker+implantation.+%0AMethods%3A+The+pacemaker+lead+to+be+extracted+was+released+from+the+generator+and+retaining+sutures+at+the+implantation+site.+The+lead+was+then+grabbed+from+below+using+a+needle-eye-snare+or+basket.+The+lead+was+then+cut+short+and+a+drag+through+technique+performed+where+a+guide+wire+was+pushed+into+the+gap+between+the+insulation+and+the+coil.+This+guide+wire+was+then+drawn+into+the+right+atrium+as+the+lead+was+pulled+down+from+below.+This+guide+wire+was+then+used+to+introduce+a+sheath+through+which+a+replacement+lead+could+be+inserted.%0AResults%3A+A+total+of+34+consecutive+patients+(21+male%2C+aged+63%C2%B114+years%2C+mean%C2%B1SD)+had+57+(1.7%2Fpatient)+leads+extracted.+Fourteen+patients+required+implantation+of+a+new+system+and+were+suitable+for+immediate+lead+replacement+using+the+drag+through+technique.+All+leads+were+successfully+extracted%2C+with+5+partial+successes+(9.1%25+of+leads).+The+drag-through+technique+was+successful+in+all%2C+including+4+with+subclavian+vein+occlusion.+Procedure+and+fluoroscopy+times%2C+including+the+time+required+for+implantation+of+a+new+system%2C+were+143%C2%B165+mins+and+31%C2%B123+mins+respectively.+There+were+no+complications+and+hospital+stay+was+1.6%C2%B11.2+days+for+patients+undergoing+the+drag-through+procedure.%0AConclusion%3A+The+drag-through+technique+can+be+successfully+used+to+provide+access+in+order+to+replace+pacemaker+leads+removed+using+a+femoral+approach.&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=2003-01&rft.type=Journal+(Paginated)&rft.type=PeerReviewed&rft.format=text%2Fhtml&rft.identifier=http%3A%2F%2Fcogprints.org%2F4297%2F1%2Fschilling.htm&rft.identifier=++Staniforth%2C+Andrew+D+and+Schilling%2C+Richard+J++(2003)+Reuse+of+Occluded+Veins+During+Permanent+Pacemaker+Lead+Extraction%3A+A+New+Indication+for+Femoral+Lead+Extraction.++%5BJournal+(Paginated)%5D+++++&rft.relation=http%3A%2F%2Fcogprints.org%2F4297%2F