A Case of Lead Extraction with Excimer Laser Sheath via Cephalic Vein

DOI Web Site 8 References
  • Sonoda Masahiro
    1 Department of Cardiology, National Hospital Organization Kagoshima Medical Center
  • Tanoue Kazuyuki
    1 Department of Cardiology, National Hospital Organization Kagoshima Medical Center
  • Yamashita Erika
    1 Department of Cardiology, National Hospital Organization Kagoshima Medical Center
  • Sai Eikou
    1 Department of Cardiology, National Hospital Organization Kagoshima Medical Center
  • Tanaka Hideki
    1 Department of Cardiology, National Hospital Organization Kagoshima Medical Center
  • Nuruki Norihito
    1 Department of Cardiology, National Hospital Organization Kagoshima Medical Center
  • Aoki Megumi
    2 Department of Dermatology, National Hospital Organization Kagoshima Medical Center
  • Saho Shozo
    3 Department of Anesthesiology, National Hospital Organization Kagoshima Medical Center
  • Nomoto Mitsuharu
    4 Department of Surgical Pathology, National Hospital Organization Kagoshima Medical Center
  • Ueno Takayuki
    5 Department of Cardiovascular Surgery, National Hospital Organization Kagoshima Medical Center
  • Fukumoto Yoshihiro
    5 Department of Cardiovascular Surgery, National Hospital Organization Kagoshima Medical Center

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Other Title
  • エキシマレーザーシースによる橈側皮静脈からのリード抜去症例
  • Perspective from E-journals in J-STAGE

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<p>An excimer laser sheath has recently been used to cardiac implantable electronic devices（CIEDs）leads. We report the case of lead extraction using this system in a 72-year-old man who had developed a pacemaker infection with pain and swelling in the pacemaker pocket. He had undergone pacemaker implantation（DDD mode）10 years previously, and 16 months had passed since generator replacement. The right atrium（RA）lead had been inserted via the right subclavian puncture and the right ventricular（RV）lead via cut-down of the right cephalic vein. The RA lead was extracted without complication. During extraction of the RV lead, we easily excised the adhesions and smoothly advanced the sheath over the lead. As the procedure continued, however, the tip of the sheath reached the superior vena cava, where we met resistance and could hardly advance the sheath, eventually no longer being able to push it forward over the RA. The tip of the lead had already detached from the RV, and the lead itself was free from any adhesions. Although it was impossible to pull the lead backward into the sheath, we finally removed the entire system. Tissue from the compressed vein was evident around part of the lead and apparently had caused locking of the lead and sheath. This unfavorable situation deserves careful attention when attempting to extract of a lead using an excimer laser sheath via the cephalic vein.</p>

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