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There are no „simple lead extraction” Young lady & old leads – terribme mariage Promnice 2014
Andrzej Kutarski Lublin (a_kutatski@yahoo.com)
www.usuwanieelektrod.pl
Only FACE SWELLING and slight edema of hands
16-y 16-y
11-y
Begnning of SCV syndrome ??? !!!
Parasternal subclavian vein puncture – birth sin of later crush syndrome and secondary problems
As for 42-y in good health woman, the system is not in optimal condition optimal...
Some blood flow disturbances in SCV seems to be sure...
First attempt. We tray to grasp with loop the broken atrial lead. It was extreme optimism
www.usuwanieelektrod.pl a_kutarski@yahoo.com
Everytime we grasped (with loop) ALL 3 lead simulyaneously !!!
X-ray machine told STOP (overheating)
There is no TLE taking a short cut
It was the end of procedure in May
The second attempt – one day – one procedure
Start 10:40 AM !!!!!!!!
www.usuwanieelektrod.pl a_kutarski@yahoo.com
No „short-cuts”; step-by step procedure
First step – functional leads extraction
No „short-cuts”; step-by step procedure
First step – functional leads extraction
No „short-cuts”; step-by step procedure
First step – younger (11-y) RAA lead extraction
No „short-cuts”; step-by step procedure
First step – younger (11-y) RAA lead extraction
No „short-cuts”; step-by step procedure
All leads connected strongly in the one block
First step – younger (11-y) RAA lead extraction www.usuwanieelektrod.pl a_kutarski@yahoo.com
First success – younger (11-y) RAA lead extraction
RAA lead extraction ď Š And we obtained venous aproach (guidewire via Byrd dilator)
Guide-wire – we keep Lt subclawian approach Old broken atrial UP lead
Onset of functional old UP vntricular lead extraction
Old broken atrial UP lead
Extraction of old UP RVA lead. Fatal previous place of subclavian vein puncture (parasternal)
www.usuwanieelektrod.pl a_kutarski@yahoo.com
Extraction of old UP RVA lead ... Extracted lead break
ď Œ
Guidewire = superior apprach
We left broken V lead and we come back to broken RAA lead extraction. First step – to release proximal ending of lead with a loop Extraction of old UP RVA lead.
Two seperate inferior approachs (pig-tail & guidewire
RAA lead
First step for of old UP RAA lead extraction – to release proximal ending of lead with a loop
Broken fragment of RVA lead
Superior and inferior approach („combined approach”)
Our „standard loop”: pig-tail cath. with guidewire
Start 10:40 AM !!!!!!!!
Our „standard loop�: pig-tail cath. with guidewire The loop is closed with basket catheter (second arm)
Start 10:40 AM !!!!!!!!
We pull-down the loop to release proximal RAA lead ending
We pull-down the loop to release proximal RAA lead ending
We released distal ending (tip) of 16-y atrial lead ... brrrr....
Guidewire (superior approach) Broken RVA lead fragment Free didtal ending of RAA lead
Grasp of atrial lead usind femoral approach (using the same basket catherer)
Drawing of atrial lead with basket catherer
Broken RVA lead fragment
www.usuwanieelektrod.pl a_kutarski@yahoo.com
Released proximal ending of atral lead
Broken RVA lead fragment
And ... ď Š Reserve approach
Single guidewire was replaced by onother one and CS lead designed Attain introducer
Soft, more gentle NITINOL basket catheter inside attain sheath to grasp ending of brken RVA lead fragment
Reserve superior approach
Proximal endinf of lead remnant grsped with baslet catheter inside the attain sheath „Extender of lead fragment�
Start 10:40 AM !!!!!!!!
Byrd dlator (internal, green) over the „extender of lead fragment�
Reserve superior approach
Reserve inforior approach www.usuwanieelektrod.pl a_kutarski@yahoo.com
Byrd dlator (internal, green) over the „extender of lead fragment� Conventional extraction by rotation Reserve superior approach
Reserve inforior approach
Byrd dlator (internal, green) over the „extender of lead fragment� Conventional extraction by rotation Reserve superior approach
Reserve inforior approach
The new DDD system ď Š
Reserve superior approach remooveed
Reserve inforior approach remooved
The new DDD system ď Š
Long term FU: partial narrowing if SCV still present but only in venography Face and hand swelling ceased ď Š
Start 10:40 AM !!!!!!!!
„Landscape after the battle”
Proxilal ending of broken atrial lead
Multiple intracardiac lead abrasions
This time we were before lead dependent endocarditis
Young lady & old leads – terribme mariage
Conclusions: 1. Delayed „spring-cleaning” may be terrible for the operator 2. We were only slight before or lead related endocarditis (lead abrasions) or before superior cava vein syndroime appearance
www.usuwanieelektrod.pl a_kutarski@yahoo.com
Thanks for your attention Masz problem ? wyślij e-mila na:
a_kutarski@yahoo.com www.usuwanieelektrod.pl