4 years ago

Unrecognized Venous Injuries After Cardiac Implantable Electronic Device Transvenous Lead Extraction

Unrecognized Venous Injuries After Cardiac Implantable Electronic Device Transvenous Lead Extraction
Major complication rate of transvenous lead extraction (TLE) is estimated around 1-2.0%. Laceration of the central veins can be fatal. Objectives: to define the incidence and extent of venous injuries on a microscopic level after TLE and compare it with the incidence of clinically documented events of venous laceration. Methods We studied all patients who underwent TLE at our tertiary center within 30 months via a variety of techniques. Extracted leads and tissue around them were fixed in formalin. Pathologic examination was standardized to examine the leads identifying the areas covered by tissue cuffs along the length of the lead. The cuffs were removed and sectioned transversely to their longitudinal axis. Microscopic examination was performed using H&E and Movat stains to identify the presence of vein tissue. Results Four hundred sixty one patients (63±15 years) had a total of 861 leads extracted (585 pacemaker and 272 defibrillator leads) with an average of 1.9 leads per patient and a median lead age of 2,546 days. Upon microscopic review, 80 leads (9.3%) in 72 out of the total 461 patients (15.6%) demonstrated segments of vein, the majority of which were transmural (Venous tissue including adventitia). Despite this finding, only five (1.1%) catastrophic complications occurred that required emergent surgical intervention. Risk factors for venous injury included ICD lead, age of lead, and the use of laser sheath. Conclusions Microscopic venous injuries during lead extraction are common but often not recognized clinically.

Publisher URL: www.sciencedirect.com/science

DOI: S154752711731322X

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