Prevalence of venous occlusion in patients referred for lead extraction: Implications for tool selection

Abstract

Aims: Data concerning the incidence of venous obstruction in patients referred for lead extraction is limited. Thus,we aimed to assess the incidence of venous obstruction in patients referred for lead extraction and the implications for tool selection. Methods and results: Contrast venographyof the access veinwas obtained in202patients (147men;meanage,62.4±14.5 years) scheduledfor lead extraction. The indication for lead extraction included infection (n = 145, 72%) and other causes (n = 57, 28%). Two patients withdevice infectionhad superior venacavalocclusion.Access veinocclusionoccurredin6(11%)patients without infection vs. 46 (32%) patients with infection [P = 0.002; odds ratio (OR) 3.94; 95% confidence interval (CI) 1.58-9.87]. No significant differences between occluded and non-occluded patients were seen for age, sex, device type, number of leads, time from implant of the initial lead, or anticoagulation therapy (all P > 0.05). Procedural duration and fluoroscopy exposure time were significantly lower in the open group than in the occluded group (P< 0.05). Patients with venous occlusion required more advanced tools for lead extraction, such as dilator sheaths, evolution sheaths, and needle's eye snares (P = 0.019). Conclusion: Both systemic and local infections are associated with increased risk of access vein occlusion.We found no support for the hypothesis that venous occlusion increases with the number of leads present. Lead extraction was more difficult in patients with venous occlusion, requiring advanced tools and more time. Published on behalf of the European Society of Cardiology. All rights reserved.