Transvenous Lead Extraction: From Simple Traction to Internal Transjugular Approach PDF
Preview Transvenous Lead Extraction: From Simple Traction to Internal Transjugular Approach
Transvenous Lead Extraction Maria Grazia Bongiorni Editor Transvenous Lead Extraction From Simple Traction to Internal Transjugular Approach Foreword by Bruce L.Wilkoff ~ Springer Editor MariaGrazia Bongiorni 2nd Cardiovascular Department AOUP,Santa Chiara University Hospital Pisa, Italy ISBN 978-88-470-1465-7 N 978-88-470-1466-4 DOl 10.1007/978-88-470-1466-4 SpringerMilanDordrecht Heidelberg London NewYork LibraryofCongressControlNumber:2010941859 ©Springer-Verlag Italia20II Thisworkissubjecttocopyright.Allrightsarereserved,whetherthewholeorpartofthematerialisconcerned,specificallytherightsof translation,reprinting,reuseofillustrations,recitation,broadcasting,reproductionon microfilm or inanyother way,and storage indata banks.Duplicationofthispublication orpartsthereofispermittedonlyundertheprovisionsoftheItalianCopyrightLawinitscurrentver sion,andpermissionforusemustalwaysbeobtained fromSpringer.Violationsareliabletoprosecutionunderthe ItalianCopyrightLaw. Theuseofgeneraldescriptivenames,registerednames,trademarks,etc.inthispublicationdoesnotimply,evenintheabsenceofaspeci ficstatement,thatsuchnamesareexemptfromtherelevantprotectivelawsandregulationsandthereforefreeforgeneraluse. Productliability:Thepublisherscannot guaranteetheaccuracyofanyinformation aboutdosageandapplication containedinthisbook. In everyindividualcasetheusermustchecksuchinformationbyconsultingtherelevantliterature. 9 8 7 6 5 4 3 2 I 2011 2012 2013 2014 Coverdesign:SimonaColombo,Milan,Italy Typesetting:Graphostudio,Milan,Italy Printingandbinding:PrinterTrentoSri,Trento, Italy Printed inItaly Springer-VerlagItaliaS.r.l.- ViaDecembrio28- 1-20137Milan SpringerisapartofSpringerScience-BusinessMedia(www.springer.com) Dedicated to allpatientsdealing with device-relatedcomplications and toalldoctors andnursesdevoting theirlives to carefor them Foreword The evolution of the management of transvenous leads has been born out of the furnace of clinical care and the pathophysiology of lead dysfunction. Transvenous lead extraction is only one tool in the management tool chest. At first it wasn't much ofa tool, just a rag tag group ofideas used by a few people trying to solve problems for patients without a solution. However, over the last 25 years and particularly with the visionary efforts of Dr. Charles Byrd and his creativecollaboration with Cook PacemakerInc. (now CookVascularInc.), trans venous lead extraction is not only a tool but an armory oftechniques. There were many steps to the elevation ofthese ideas to an accepted solution, practicedby many; tools continuouslyevolvingand acommunity developedover years,resultspublished,passionateteachers, minorandmajorcomplications,fatal mistakes, disparate ideas, society guidelines and all progressing due to the ongo ing clinical need to solve problems. It is an important story and a one well told by Dr. Bongiorni and hercolleagues. How do we teach our hard learned lessons to the nextgeneration ofphysicians? Can we preventfuture mistakes from being made? We must commit ourselves to recording, analysis and communication. This book on lead extraction is unique and systematic and it is my prayer that it is neverleft on the shelfbut studied intently and built upon endlessly. February2011 BruceL. WilkoffMD DirectorCardiac PacingandTachyarrhythmia Devices DepartmentofCardiovascularMedicine ProfessorofMedicine ClevelandClinic LernerCollege ofMedicine ofCaseWesternReserve University Cleveland, Ohio Preface "Icando it...,Icando it...,Ican do it..."Thisaffirmationcouldberead on pins on jackets of many participants of the Cardiac Pacing and Arrhythmology Congress in 1989. These simple words mean that a procedure for transvenous lead extraction was now a possibility. One participant was a dear Italian friend of mine, a salesman, who showed me some tools for lead extraction that had recently been produced by an American company, Cook Pacemaker, Inc., incol laboration with agenius in thefield, Dr. Charles Byrd (thefather ofleadextrac tion). At that time, there were three different opinions about lead extraction: most physicians were unbelievers; many were frightened by the idea; and some were simply curious. I was in the latter group. My interest came from the fol lowing: (1) many patients could benefit from transvenous lead extraction (at that time, I had a patient with lead-related endocarditis); (2) some years earlier, my professorbegan extracting transvenous leads using empirical tools (weights, pulleys, etc.) and, if not for his premature death, would have fully appreciated possibility of safe transvenous lead extraction; (3) if my clever and forward looking friend was wearing the pin being displayed at the 1989 congress, it would have meant that, in his opinion, transvenous lead extraction was coming ofage. So, my professional journey into transvenous lead extraction began like a fairy tale ("Once upon a time..."), starting with a clinical need, enhanced by intellectual curiosity, and guided by a lucky star that put the right people in the right place at the right moment. Since that time, there has been great progress in the field, and transvenous lead extraction is becoming a widespread procedure in many arrhythmology centers, with increasing indications for its performance. Consequently, physi cians feel the needfor recommendations, indications, training, equipment, facil ities, and other guidelines for performing transvenous lead extraction. Subsequently, the most important scientific organizations have responded to these needs. Many publications are now available regarding this subject, reflect ing an obviously increasing interest in solving cardiac pacing and defibrillation lead-related complications. This book is the result of20 years ofpersonal expe rience in this field, and it is addressed to young cardiologists and arrhythmolo gists, as well as to nurses and technicians, who want to learn about lead extrac tion. Lead extraction is atrue team procedure. All participants mustknow - and keep in mind- the interactionbetween the leadand the cardiovascularstructure, removal indications, patient preparation, extraction tools and techniques, and complication management in order to achieve the best possible outcomes. This volume describes, in particular, an innovative approach to transvenous lead extraction - the internal jugular vein approach - which is used to extract leads otherwise difficult to remove from the venous entry site or via thefemoral vein. x Preface This is the first edition ofthis book, the authors having been selected from the Pisa School in orderto provide cohesive information while avoiding redundan cies and contradictions. In future additions, advances in this increasingly important field of medicine will be described. I thank the many people who contributed to the realization ofthis book. First, sincerethanks to my great pro fessor Carlo Contini for teaching me about arrhythmology but especially for teaching me to care about my patients. Next, heartfelt thanks to my coworkers, all ofwhom devoted much time to this book. A special thanks to "tireless" Dr. Ezio Soldati for his constant support and ability to graphically reproduce ideas and actions, and to Dr. Raffaele De Lucia for the book's arrangement. Transvenous lead extraction demands a team effort, so thank you to my long devoted and passionate nurses, Giampietro Ercoli, Michela Favaro, Cristina Giannessi, and Mascia Sarti, and to Guglielmo Liva e Susy Bardelli, who recentlyjoinedourteam. My thanks also to the University Hospital cardiac sur geon and anesthesia team for their invaluable support, and thanks to all cardi ologists and nurses who care for these fragile patients during preparation for surgery and postoperatively. Finally, a sweet thought to my parents, Teresa and Ernesto, who - through great sacrifice - made my studies and my wonderful profession possible. Pisa, February2011 Maria Grazia Bongiorni, MD Contents 1 ImportanceofKnowing lead and Patient Interaction . Raffaele DeLucia,Giovanni Coluccia,StefanoViani and Luca Paperini 1.1 Structure,Function,and Clinical AspectsofPacemaker and DefibrillatorLeads............................................... 1 1.1.1 PacemakerLeads...................................................... 1 1.1.2 ImplantableCardioverter- DefibrillatorLeads................... 10 1.1.3 Lead Shapes 16 1.1.4 Special Leads........................................................... 16 1.1.5 Lead-related Problemsand Extraction 17 1.1.6 What Do Lead ExtractorsWantto SeeImproved in FutureCardiacLead Designand Materials? 18 1.2 PatientAnatomy....................................................... 22 1.2.1 Vein Anatomy.......................................................... 22 1.2.2 VenousApproaches................................................... 24 1.2.3 Critical Anatomical Regionsfor Lead Extraction................. 25 1.3 Patient-Lead Interaction............................................. 26 1.3.1 Fibrous Responseto IntravascularForeign Bodies 26 1.3.2 VascularComplications Related to Fibrous Response........... 28 References....................................................................... 30 2 From Guidelines:Definitions,Indications,Facilities, and Outcomes ofTransvenous lead Extraction 33 RobertoVerlato,Maria Stella Baccillieri and PietroTurrini 2.1 Introduction............................................................ 33 2.2 Indicationsfor Lead Removal:Infections.......................... 33 2.3 IndicationsforLead Removal:Chronic Pain....................... 41 2.4 IndicationsforLead Removal:Venous StenosisorOcclusion.. 41 2.5 Indicationsfor Lead Removal:Functional and Nonfunctional LeadsWithoutInfection.............................................. 42 References....................................................................... 43 XII Contents 3 Perioperative ManagementofTransvenous Lead Extraction 47 Gianluca Solarino,Andrea Di Cori and GiulioZucchelli 3.1 Introduction............................................................ 47 3.2 PreoperativeEvaluation.............................................. 47 3.2.1 Historyand Physical Examination.................................. 47 3.2.2 Transvenous Lead Extraction Consensus 49 3.2.3 LaboratoryTests....................................................... 49 3.2.4 ChestX-Ray............................................................. 49 3.2.5 Echocardiography 50 3.2.6 PatientPreparation 50 3.2.7 Equipment.............................................................. 52 3.2.8 Staff............... .......... .......... 52 3.2.9 Intervention Room.................................................... 53 3.2.10 StandbySurgery....................................................... 53 3.3 PostoperativeManagement......................................... 53 3.3.1 AntibioticTreatment................... .......... 54 References................ .......... .......... 55 4 Tools,Techniques, and Approaches............................... 57 Luca Segreti,EzioSoldatiand Maria Grazia Bongiorni 4.1 Definitions.............................................................. 57 4.1.1 Lead Extraction Basis................................................. 57 4.2 ExtractionTools........................................................ 58 4.2.1 ImplantTools 59 4.2.2 Traction Devices....................................................... 59 4.2.3 Mechanical Sheaths................................................... 61 4.2.4 LaserSheaths 63 4.2.5 Electrosurgical Sheaths............................................... 64 4.2.6 RotatingThreaded-TipSheath...................................... 65 4.2.7 OtherExtraction Devices 65 4.2.8 FemoralTools.......................................................... 66 4.3 Techniquesfor Lead Extraction..................................... 68 4.3.1 LeadTraction........................................................... 68 4.3.2 Counterpressureand Countertraction............................. 69 4.3.3 Progressive Dissection and Mechanical Dislodgement......... 71 4.4 Approaches............................................................ 71 4.4.1 Venous EntryApproach............................. .... 72 4.4.2 Transfemoral Approach 76 4.4.3 InternalTransjugularApproach..................................... 79 References....................................................................... 80
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