Successful avoidance of superior vena cava injury during transvenous lead extraction using a tandem femoral-superior approach

Heart Rhythm. 2022 Jul;19(7):1104-1108. doi: 10.1016/j.hrthm.2022.02.024. Epub 2022 Mar 1.

Abstract

Background: Transvenous pacemaker and defibrillator lead extraction is a higher risk procedure with variation in preferred technique. A frequently fatal complication of this procedure is perforation of the superior vena cava. We have developed a tandem femoral-superior technique that incorporates snaring of targeted leads from a femoral approach combined with use of a rotational cutting sheath advanced over the lead from the subclavian vein.

Objective: We sought to evaluate the safety and efficacy of a tandem femoral-superior approach to lead extraction.

Methods: Consecutive patients undergoing transvenous extraction of at least 1 pacemaker or defibrillator lead with implant duration ≥1 year in which a tandem femoral-superior technique was used as the initial extraction strategy were included. The registry spanned 2010-2018 and consisted of procedures performed by a single primary operator.

Results: A total of 131 patients were included. A total of 267 leads with a mean implant duration of 9.8 years, including 90 defibrillator leads (33.7%), were targeted for extraction. No superior vena cava perforation or other vascular damage occurred. Clinical procedural success was achieved in 96.2% of cases. There were 5 major complications (3.8% of patients), with 3 being pericardial effusion requiring intervention. There were no deaths.

Conclusion: A tandem femoral-superior approach to lead extraction effectively eliminated superior vena cava injury. This is a safe and effective technique for transvenous lead extraction.

Keywords: Complications; Implanted cardiac defibrillator; Lead extraction; Pacemaker; Superior vena cava.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, N.I.H., Extramural

MeSH terms

  • Defibrillators, Implantable* / adverse effects
  • Device Removal / methods
  • Humans
  • Pacemaker, Artificial* / adverse effects
  • Retrospective Studies
  • Thoracic Injuries*
  • Treatment Outcome
  • Vena Cava, Superior / injuries
  • Vena Cava, Superior / surgery