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TLE nightmares „Suboptimal manegement” of pocket incection in high volume PM Center anno 2007 and it interesting long-term effect Promnice 2014
Andrzej Kutarski Lublin (a_kutatski@yahoo.com)
www.usuwanieelektrod.pl
In case of chronic pocket infection whole system have to be remooved. There is no other option (HRS Guidelines 2000 and 2009)
Non-standard management of infection and (very) long-term observation of leads slided down into CVS History: 1998 implantation DDD system 2007 unit replacement, infection, PM removal but abandonnent both of leads in infected pocket (cutted as short as possible) 2007 simultaneous VDD system impl. right side 2007-2013 observation of both leads dropped into CVS 2013 Lead Dependent Infective Endocarditis (LDIE)
Non-standard management of infection and (very) long-term observation of dropped leads (into CVS) Preoperative X-ray findings
Such leads location + LDIE (lead dependent infective endocarditis) – now we have class 1 for TLE; was not indicated earlier ?
Non-standard management of infection and (very) long-term observation of dropped leads First stage of procedure – VDD lead / system extraction
Non-standard management of infection and (very) long-term observation of dropped leads
Severe problem with SCV caused by dropped leads
www.usuwanieelektrod.pl a_kutarski@yahoo.com
Venography performed using hemodilysis double lumen catheter
Procedures were pefrormen in cardiac surgery operating room. As all potentially dangerous TLE procedures
Non-conventional femoral approach (two Attain sheths – designed for CS lead implantation)
Inside one sheath pig-tail catheter witjh guidewire, and inside another one – lasso catheter to make the loop over the lead
Prox. ending od RVA lead in cava vein; it was grasped with lasso (previously utilised to make the loop)
... and SURPRISE !!! (KNOT)
Extra long orange internal Byrd dilator over tha Attain and STOP (to small diameter; external one was to short)
www.usuwanieelektrod.pl a_kutarski@yahoo.com
Pulling down atrial lead; tip was released as first one !
Another reserve femoral approch bacause situation stays difficult ...
Grasping of proximal ending of atrial lead (without knot) and removal ot this atrial lead
Decisive battle and X-ray machine overheating
16-F exrernal catheter of Femoral Working Station – distal ending scarted (skiwed) – „mega-long teflon Bydr dilator”
Knot inside FWS catheter
Already above the knot Rotation of ccart 16 F catheter – it works as teflon Byrd dilator
Finis coronat opus ?
www.usuwanieelektrod.pl a_kutarski@yahoo.com
Removed leads on the table
www.usuwanieelektrod.pl a_kutarski@yahoo.com
Only 38 min of X-ray scopy but the lady was Proximal ending of infected lead fat and it was to much having 7 year dwelling time in the for machine
pulmonary artery !!!)
New double-lumen catheter for hemodialysis (vancomycin) via Rt femoral vein. Due to arterial bleeding from Lt femoral artery limited surgical intervention (effective) vas necessary
Double-lumn catheter renoved from jugular approach (problem with superior cava
Conclusions Only PM romovl with abndonment of infected leads in PM
pocket consists big mistake with serious later consequences
Leads with slided into CVS proximal ending should be extracteg as soon as possible; „conservatiwe treatment” (observation) such of leads may lead to lead-dependent endocrditis (LDIE) TLE of leads having proximal ending slided into CVS should be left for professionalist. Utility of large spectrum of non-conventional tools mey be necessary TLE of leads hving proximal ending slided into CVS consists more ART tham standard medical procedure
Thanks for your attention Masz problem ? wyślij e-mila na:
a_kutarski@yahoo.com www.usuwanieelektrod.pl