Intravascular Extraction of Chronic Pacemaker Leads: Efficacy and Follow‐Up
Intravascular Extraction of Chronic Pacemaker Leads: Efficacy and Follow‐Up
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血管内拔除慢性起搏器导联：疗效和随访
DOI：
10.1111/j.1540-8159.1993.tb02346.x
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发表时间：
1993
期刊：
影响因子：
--
通讯作者：
HEIDI J. Smith
中科院分区：
文献类型：
--
作者：
P. G. Colavita;S. Zimmern;J. Gallagher;J. Fedor;W. K. Austin;HEIDI J. Smith
慢性起搏器导联的拔出已被推荐用于感染、预防静脉血栓形成、移位和可能的穿孔。持续牵引技术的成功一直是可变的，而且开胸手术的成本和发病率是令人望而却步的。分析了一种血管内技术提取铅的新系统的效果。该系统（库克起搏器）使用一个锁定针，通过逆时针旋转固定在远端电极上，以加强导线并促进牵引，扩张器鞘用于将导线从静脉系统的粘连中解放出来。56例患者（年龄19-88岁）因糜烂（5例）、感染（14例）、铅置换（35例）或其他原因（2例）而提出拔铅，其中86例被拔铅。心房导联32例，心室导联54例；主动固定23例，被动固定63例。平均种植时间为58±42个月（范围1-264）。84根导联被完全移除，2根部分移除。对于这两根导联，远端尖端未被移除；在这两种情况下，由于引线内的阻塞，锁定针没有固定在远端电极上。2例患者术后出现手臂水肿，并随抬高而消退。1例患者出现锁骨下血栓形成，经华法林抗凝治疗。四名患者因无关原因死亡。总之，这种血管内方法用于拔出慢性导联是有效的，并且在有经验的人员操作时是安全的。
Extraction of chronic pacemaker leads has been recommended for infections, prevention of venous thrombosis, migration, and possible perforation. Success with constant traction techniques has been variable, and the cost and morbidity of open chest surgical procedures are prohibitive. Efficacy of a new system for lead extraction using intravascular techniques was analyzed. The system (Cook Pacemaker) uses a locking stylet, which is secured at the distal electrode by counterclockwise rotation to reinforce the lead and facilitate traction, and dilator sheaths that are used to free the lead from adhesions in the venous system. In a series of 56 patients (ages 19–88)who presented for lead extraction because of erosion (5), infection (14), lead replacement (35), or other (2), 86 leads were extracted. Thirty‐two were atrial leads and 54 ventricular; 23 had active fixation and 63 passive. Average duration of implant was 58 ±42 months (range 1–264). Eighty‐four leads were totally removed and two partially removed. For these two leads, the distal tip was not removed; in both cases the locking stylet was not secured at the distal electrode due to obstruction within the lead. Two patients developed arm edema following the procedure, which resolved with elevation. One patient developed a subclavian thrombosis, which resolved with warfarin anticoagulation. Four patients have expired due to unrelated causes. In conclusion, this intravascular approach for extraction of chronic leads is effective, and the procedure is safe when performed by experienced personnel.