"Retained wire femoral lead removal and fibroplasty" for obtaining venous access in patients with refractory venous obstruction.

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Citation: Journal of Cardiovascular Electrophysiology. 32(10):2729-2736, 2021 10.PMID: 34374160Institution: MedStar Heart & Vascular Institute | MedStar Washington Hospital CenterDepartment: Clinical Cardiac Electrophysiology FellowshipForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: *Defibrillators, Implantable | *Pacemaker, Artificial | Device Removal/ae [Adverse Effects] | Femoral Artery | Humans | Retrospective StudiesYear: 2021ISSN:
  • 1045-3873
Name of journal: Journal of cardiovascular electrophysiologyAbstract: BACKGROUND: Patients with wire and catheter refractory venous occlusion are traditionally referred for pectoral transvenous lead extraction (TLE) to obtain venous access. TLE causes 1-2 mm circumferential mechanical or laser destruction of tissue surrounding the lead(s). This not only exposes the patient to the risk of major complications but also can damage nontargeted leads. We present a series of patients where retained wire femoral lead removal and fibroplasty was used to obtain venous access in patients with refractory obstruction.CONCLUSION: Retained wire femoral lead removal and fibroplasty is safe and highly efficacious at obtaining venous access in patients with refractory venous occlusion. If the target lead(s) is less than or equal to 1 year old, this technique can help obtain venous access at the time of the initial surgery, hence avoiding the need for TLE. Furthermore, in patients referred for TLE to obtain venous access, this technique by avoiding the use of TLE tools spares the patient of the associated risks. Copyright (c) 2021 Wiley Periodicals LLC.METHODS: Between 2008 and 2021, we identified 17 patients where retained wire lead removal followed by fibroplasty was used to retain venous access. Demographic and procedural data were obtained by retrospective review of patient charts.RESULTS: We were able to successfully obtain venous access in all 17 patients in whom this technique was attempted. In two patients the target lead was less than or equal to 1 year old. In the remaining 15 patients, the average dwell time of the target lead(s) was 6 years. There were no procedure-related complications, and no changes in the parameters of other leads were noted.All authors: Bansal S, Brar V, Eldadah Z, Makanjee B, O Donoghue S, Oza S, Steen T, Worley SJOriginally published: Journal of Cardiovascular Electrophysiology. 32(10):2729-2736, 2021 Oct.Fiscal year: FY2022Fiscal year of original publication: FY2022Digital Object Identifier: ORCID: Date added to catalog: 2021-11-01
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Journal Article MedStar Authors Catalog Article 34374160 Available 34374160

BACKGROUND: Patients with wire and catheter refractory venous occlusion are traditionally referred for pectoral transvenous lead extraction (TLE) to obtain venous access. TLE causes 1-2 mm circumferential mechanical or laser destruction of tissue surrounding the lead(s). This not only exposes the patient to the risk of major complications but also can damage nontargeted leads. We present a series of patients where retained wire femoral lead removal and fibroplasty was used to obtain venous access in patients with refractory obstruction.

CONCLUSION: Retained wire femoral lead removal and fibroplasty is safe and highly efficacious at obtaining venous access in patients with refractory venous occlusion. If the target lead(s) is less than or equal to 1 year old, this technique can help obtain venous access at the time of the initial surgery, hence avoiding the need for TLE. Furthermore, in patients referred for TLE to obtain venous access, this technique by avoiding the use of TLE tools spares the patient of the associated risks. Copyright (c) 2021 Wiley Periodicals LLC.

METHODS: Between 2008 and 2021, we identified 17 patients where retained wire lead removal followed by fibroplasty was used to retain venous access. Demographic and procedural data were obtained by retrospective review of patient charts.

RESULTS: We were able to successfully obtain venous access in all 17 patients in whom this technique was attempted. In two patients the target lead was less than or equal to 1 year old. In the remaining 15 patients, the average dwell time of the target lead(s) was 6 years. There were no procedure-related complications, and no changes in the parameters of other leads were noted.

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