This site has been permanently archived. This is a static copy provided by the University of Southampton.
--- abstract: |- Objectives: This study examined the utility of a novel technique for reuse of thrombosed veins when extracting permanent pacemaker leads via a femoral vein approach. Background: Although lead extraction permanent pacemaker using a femoral approach has advantages over the subclavian approach, it cannot be used to provide access for a new lead using currently employed techniques. This is important because up to 23% of patients have occluded veins after permanent pacemaker implantation. Methods: 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. Results: A total of 34 consecutive patients (21 male, aged 63�14 years, mean�SD) had 57 (1.7/patient) 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, with 5 partial successes (9.1% of leads). The drag-through technique was successful in all, including 4 with subclavian vein occlusion. Procedure and fluoroscopy times, including the time required for implantation of a new system, were 143�65 mins and 31�23 mins respectively. There were no complications and hospital stay was 1.6�1.2 days for patients undergoing the drag-through procedure. Conclusion: The drag-through technique can be successfully used to provide access in order to replace pacemaker leads removed using a femoral approach. altloc: - http://www.ipej.org/0204/schilling.htm chapter: ~ commentary: ~ commref: ~ confdates: ~ conference: ~ confloc: ~ contact_email: ~ creators_id: [] creators_name: - family: Staniforth given: Andrew D honourific: '' lineage: '' - family: Schilling given: Richard J honourific: '' lineage: '' date: 2003-01 date_type: published datestamp: 2005-05-02 department: ~ dir: disk0/00/00/42/97 edit_lock_since: ~ edit_lock_until: ~ edit_lock_user: ~ editors_id: [] editors_name: - family: Singh given: Balbir honourific: '' lineage: '' - family: Lokhandwala given: Yash honourific: '' lineage: '' - family: Francis given: Johnson honourific: '' lineage: '' - family: Gupta given: Anup honourific: '' lineage: '' eprint_status: archive eprintid: 4297 fileinfo: /style/images/fileicons/text_html.png;/4297/1/schilling.htm full_text_status: public importid: ~ institution: ~ isbn: ~ ispublished: pub issn: ~ item_issues_comment: [] item_issues_count: 0 item_issues_description: [] item_issues_id: [] item_issues_reported_by: [] item_issues_resolved_by: [] item_issues_status: [] item_issues_timestamp: [] item_issues_type: [] keywords: 'pacemaker, lead extraction, femoral, drag-through' lastmod: 2011-03-11 08:56:01 latitude: ~ longitude: ~ metadata_visibility: show note: ~ number: 1 pagerange: 97-103 pubdom: TRUE publication: Indian Pacing and Electrophysiology Journal publisher: Indian Pacing and Electrophysiology Group refereed: TRUE referencetext: |- 1. Byrd CL, Schwartz SJ, Hedin NB, et al. Intravascular lead extraction using locking stylets and sheaths. PACE 1990; 13:1871-1875. 2. Wilkoff BL, Byrd CL, Love CJ, et al. Pacemaker extraction with the laser sheath: results of the pacing lead extraction with the excimer sheath (PLEXUS) trial. J Am Coll Cardiol 1999; 33: 1671-6. 3. Levy T, Walker S, Paul V. Initial experience in the extraction of chronically implanted pacemaker leads using the Excimer laser sheath. Heart 1999; 82:101-104. 4. Byrd CL, Wilkoff BL, Love CJ, Sellers TD, Turk KT, Reeves R, Young R, Crevey B, Kutalek SP, Freedman R, Friedman R, Trantham J, Watts M, Schutzman J, Oren J, Wilson J, Gold F, Fearnot NE, Van Zandt HJ. Intravascular extraction of problematic or infected permanent pacemaker leads 1994-1996. PACE 1999;22:1348-1357 5. Goto Y, Abe T, Sekine S, Sakurada T. Long-term thrombosis after transvenous permanent pacemaker implantation. Pacing Clin Electrophysiol 1998;21:1192-5 6. Smith HJ, Fearnot NE, Byrd CL, Wilkoff BL, Love CJ, Sellers TD. Five-years experience with intravascular lead extraction. U.S. Lead Extraction Database. PACE. 1994;17:2016-20. 7. Love CJ, Wilkoff BL, Byrd CL, Belott PH, Brinker JA, Fearnot NE, Friedman RA, Furman S, Goode LB, Hayes DL, Kawanishi DT, Parsonnet V, Reiser C, Van Zandt HJ. Recommendations for extraction of chronically implanted transvenous pacing and defibrillator leads: indications, facilities, training. North American Society of Pacing and Electrophysiology Lead Extraction Conference Faculty. PACE 2000;23:544-51 8. Jarwe M, Klug D, Beregi JP, Le Franc P, Lacroix D, Kouakam C, Guedon-Moreau L, Zghal N, Kacet S. Single centre experience with femoral lead extraction of permanent endocardial pacing leads. PACE 1999;22:1202-1209. 9. Goto Y, Abe T, Sekine S, Sakurada T. Long-term thrombosis after transvenous permanent pacemaker implantation. Pacing Clin Electrophysiol 1998;21:1192-5 10. Bracke FA, van Gelder LM, Sreeram N, Meijer A. Exchange of pacing or defibrillator leads following laser sheath extraction of non-functional leads in patients with ipsilateral obstructed venous access. Heart 2000;83:e12 relation_type: [] relation_uri: [] reportno: ~ rev_number: 8 series: ~ source: ~ status_changed: 2007-09-12 16:58:11 subjects: - ipej succeeds: ~ suggestions: ~ sword_depositor: ~ sword_slug: ~ thesistype: ~ title: 'Reuse of Occluded Veins During Permanent Pacemaker Lead Extraction: A New Indication for Femoral Lead Extraction ' type: journalp userid: 4424 volume: 3