INTRAVASCULAR LEAD EXTRACTION USING LOCKING STYLETS AND SHEATHS
INTRAVASCULAR LEAD EXTRACTION USING LOCKING STYLETS AND SHEATHS
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DOI：
10.1111/j.1540-8159.1990.tb06906.x
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发表时间：
1990-12-01
影响因子：
1.8
通讯作者：
SMITH, HJ
中科院分区：
文献类型：
--
作者：
BYRD, CL;SCHWARTZ, SJ;SMITH, HJ
在使用超过65种不同电极导线型号（包括被动和主动固定器械）的患者中，研究了使用血管内反牵引技术的慢性电极导线拔除术。 62例患者（平均年龄65岁）植入5天至264个月（平均58个月）的115根电极导线的取出适应症包括败血症、皮下组织感染、预腐蚀、自由浮动电极导线、电极导线卡在瓣膜中、电极导线过多、疼痛和静脉血栓形成。 在101根电极导线中尝试了上级腔静脉（SVC）入路，82次尝试成功（占总电极导线的71%）。 需要经股静脉的下腔静脉（IVC）入路来拔除14根（12%）SVC入路无法触及的电极导线和19根SVC入路失败的电极导线（占总电极导线的29%）。 上腔静脉手术包括锁定在头端的定尺寸探针和沿电极导线推进至心脏的伸缩鞘管。 IVC手术包括通过股静脉将16 F鞘工作站置入右心房。 将11 F鞘管中的偏转导管和Dotter圈套器通过工作站推进右心房。 将电极导线固定到位，圈套并拉入工作站。 对于SVC和IVC入路，通过在电极导线上施加牵引并使用鞘管反牵引来取出电极导线。 在经验丰富的手中，这些技术已被证明是安全和有效的去除慢性经静脉电极导线。
Chronic lead extraction using intravascular countertraction techniques was studied in patients with over 65 different lead models including passive and active fixation devices. Indications for removal of 115 leads implanted 5 days to 264 months (mean 58 months) in 62 patients (mean 65 years) included septicemia, subcutaneous tissue infection, preerosion, free-floating lead, lead trapped in valve, too many leads, pain, and vein thrombosis. The superior vena cava (SVC) approach was attempted in 101 leads and was successful in 82 attempts (71% of total leads). The inferior vena cava (IVC) approach via the femoral vein was required to extract 14 (12%) leads inaccessible to the SVC approach and the 19 leads that failed the SVC approach (29% of total leads). The SVC procedure includes a sized stylet locked at the tip and telescoping sheaths advanced over the lead to the heart. An IVC procedure includes placement of a 16 F sheath workstation via a femoral vein into the right atrium. A deflection catheter and Dotter snare in an 11 F sheath were advanced through the workstation into the right atrium. The lead was maneuvered into position, snared, and pulled into the workstation. For both the SVC and IVC approaches, the leads were removed by applying traction on the lead and countertraction with the sheaths. In experienced hands, these techniques have proven safe and effective for removing chronic transvenous leads.