Personal Technique and Experience: The Pisa Approach
Technological advances in transvenous lead removal can be achieved by improving the materials and tools for lead extraction or modifying the techniques and approaches. I started the activity of transvenous lead removal in S. Chiara Hospital in Pisa, Italy, in December 1989; since then, with my coworkers, we have managed more than 2,500 pacing and implantable cardioverter-defibrillator (ICD) leads . From the beginning, the technique and approaches have been continuously changed and improved, and by the beginning of 1997, we considered technique maturation to be complete . From 1994 to 1996, we experienced the internal jugular approach to remove free-floating leads, and at the beginning of 1997, we started using it also in case of standard technique failure . The first techniques I learned and applied for lead removal were traction with locking stylet, counter-pressure, and countertraction, as described by Byrd et al. , using polypropylene sheaths. Very often, we experienced the inability to insert the stylet up to the lead tip because of lead damage or stylet unlocking during traction; moreover, the force necessary to apply counterpressure and countertraction was discouraging.
KeywordsInternal Jugular Vein Lead Removal Lead Extraction Large Sheath Sheath Rotation
- 1.Bongiorni MG, Soldati E, Zucchelli G et al (2010) Transvenous removal of pacing and defibrillating leads: 13 years of experience in a single center. Heart Rhythm 7(Suppl 5) pp 36–42Google Scholar
- 2.Bongiorni MG, Soldati E, Grana M et al (1997) The internal transjugular approach: a new technique for transvenous lead removal. Proceedings of Third International Symposium on Pacing Leads Sept 11–13, 1997, Vol 1. Monduzzi Editore, Italy, pp 487–490Google Scholar
- 3.Bongiorni MG, Soldati E, Gherarducci G et al (2002) Percutaneous extraction of infected pacemaker/ICD leads: what are the current technological advances and result? In: Raviele A, ed. Cardiac arrhythmias 2001, Springer-Verlag Italia, Milan pp 623–630Google Scholar