Transjugular approach for lead extraction

Abstract

Aims: The purpose of this manuscript is to describe a transjugular extraction technique which permits the use of locking stylets and sheaths, for leads previously cut and retracted into the venous system and/or damaged during an extraction performed via the superior approach. Methods and results: A horizontal cervical incision is made over the sternocleidomastoid muscle to access the internal jugular vein between both fascicles of the muscle. The vein is ligated and through a phlebotomy a pig-tail catheter or the laparoscopic tool is introduced into the jugular vein. At the end of the procedure, a second ligature is also applied. This technique was utilized in 18 patients for the extraction of 22 leads with a mean implant duration of 91.8 months (range from 12 to 285 months). The age of the patients ranged from 19 to 87 years, (mean = 58.6 years). Out of the 22 leads extracted, 14 were ventricular pacemaker leads, 5 atrial pacemaker leads, 2 ICD leads, and 1 ventricular lead for VDD pacing. As regards the extractions, 18 were complete, 2 tips were abandoned (partial extractions), and 2 failed. Conclusion: This technique is especially useful if the leads to be extracted were previously cut and had retracted into the central circulation. Although our experience is based only on 18 patients and 22 leads, we can conclude that the success rate we have achieved was high and the complication rate was very low. © The Author 2008.