RT-100
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Internal transjugular approach
to enhance success rate and solve difficult cases in percutaneous lead removal
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Maria Grazia Bongiorni, Giuseppe
Arena, Ezio Soldati, Maria Grana*, Claudio Comite*, Mario Mariani.
Cardiovascular and Pulmonary Department, University of Pisa,
*Anesthesiology Department, Pisa, Italy
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Abstract
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Intravascular chronically implanted leads are often
particularly difficult to remove transvenously, because of the difficulty to dilate their
adherences to the venous wall and to perform countertraction using a transfemoral
approach. We developed a new technique for intravascular lead removal: in our approach, we
pass through the right internal jugular vein in order to expose the lead and successively
perform a standard procedure.
This technique was used in 13 consecutive leads, that had been implanted in 13
patients (8 males) for a mean period of 79 months. By general anesthesia or deep sedation
we performed a percutaneous puncture of the right internal jugular vein; then we used a
combination of the Cook vascular extraction kit (Dormier basket, tip deflecting wire) and
other tools (Catcher and Lassos, Osypka GmbH). The procedures were performed with
cardiosurgical standby. Using this approach we removed all the leads without serious
complications. This approach allowed a safe exposure of the intravascular leads, which
could subsequently be successfully removed.
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Key Words
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Pacing leads
removal methods, transfemoral approach, transjugular approach, OA
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