Benefits of routine prophylactic femoral access during transvenous lead extraction
| Autor: | Hermann Reichenspurner, Nils Gosau, Johannes Petersen, Till Demal, Stephan Willems, Christoph Sinning, Yalin Yildirim, Samer Hakmi, Da-Un Chung, Lisa Müller, Timm Ubben, Simon Pecha, Liesa Castro, Lukas Kaiser |
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| Rok vydání: | 2021 |
| Předmět: |
Male
medicine.medical_specialty Pacemaker Artificial medicine.medical_treatment Venography 030204 cardiovascular system & hematology 03 medical and health sciences 0302 clinical medicine Postoperative Complications Femoral access Interquartile range Risk Factors Physiology (medical) Occlusion medicine Extracorporeal membrane oxygenation Humans 030212 general & internal medicine Lead (electronics) Device Removal Aged Retrospective Studies medicine.diagnostic_test business.industry Femoral Vein Surgery Transvenous lead Defibrillators Implantable Treatment Outcome Female Cardiology and Cardiovascular Medicine business Lead extraction Follow-Up Studies |
| Zdroj: | Heart rhythm. 18(6) |
| ISSN: | 1556-3871 |
| Popis: | Background The number of patients requiring lead extraction has been increasing in recent years. Despite significant advances in operator experience and technique, unexpected complications may occur. Prophylactic placement of femoral sheaths allows for immediate endovascular access for emergency procedures and may shorten response time in the event of complications. Objective The purpose of this study was to assess the benefits of routine prophylactic femoral access in patients undergoing transvenous lead extraction (TLE) and to evaluate the methods, frequency, and efficacy of the emergency measures used in those patients. Methods We conducted a retrospective analysis of patients who underwent TLE from January 2012 to February 2019. The data were analyzed with regard to procedural complications and deployment of emergency measures via femoral access. Results Two hundred eighty-five patients (mean age 65.3 ± 15.5 years) were included in the study. Median lead dwell time was 84 months (interquartile range 58–144). Overall complication rate was 4.2% (n = 12), with 1.8% major complications (n = 5). Clinical success rate was 97.2%. Procedure-related mortality was 1.1% (n = 3). Femoral sheaths were actively engaged in 9.1% (n = 26) of cases. Deployment of snares was the most common intervention (n = 10), followed by prophylactic (n = 6) or emergency placement (n = 1) of occlusion balloons, temporary pacing (n = 3), venous angioplasty (n = 3), diagnostic venography (n = 3), and extracorporeal membrane oxygenation (n = 1). We did not observe any femoral vascular complications due to prophylactic sheath placement. Conclusion Routine prophylactic placement of femoral sheaths shortens response time and quickly establishes control in the event of various complications that may occur during TLE procedures. |
| Databáze: | OpenAIRE |
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