A rare complication of transvenous lead extraction - pulmonary embolization with a broken distal lead fragment

Unexpected Procedure Difficulties Increasing the Complexity of Transvenous Lead Extraction: The Single Centre Experience with 3721 Procedures

“…This difficulty group also included the loss of the silicone tube in the cardiovascular system. Both were removed in the next stage of the procedure [35][36][37][38][39].…”

“…As a consequence, the duration of extraction and fluoroscopy use was longer than usual [9][10][11][12][13][14][15][16][17]. However, the occurrence and significance of unforeseen obstacles/procedure difficulties such as blockages in the lead implant vein/subclavian region [19][20][21], polypropylene dilator collapse/fracture [21,22], lead-to-lead adhesion [23][24][25][26][27], lead fracture during extraction [25][26][27][28][29][30][31][32][33][34], the use of an alternative venous approach [16,21,[24][25][26][27][28][29][30][31][32]34], the loss of a broken lead fragment [34][35][36][37][38][39], or the dislodgement of functional lead have been described in case reports, but never in...…”

Incomplete Lead Removal During the Extraction Procedure: Predisposing Factors and Impact on Long-Term Survival in Infectious and Non-Infectious Cases: Analysis of 3741 Procedures

“…Procedure complexity was expressed as extraction time of all leads (sheath-to-sheath time), average time of single lead extraction (sheath-to-sheath/number of extracted leads) and use of second line and advanced tools [27][28][29][30][31]. Unexpected technical problems during TLE, i.e., the situations that increased procedure complexity but caused no complications included fracture of targeted leads [4][5][6][7][8][9][10][11][12][13][14], loss of broken lead fragments [23][24][25][26], occlusion of lead implant vein in the subclavian region, Byrd dilator collapse/fracture [32], lead-onlead binding [33], use of alternative venous access [14,33] and dislodgement of functional leads [34].…”

“…The lasso or basket catheter served as an extension of the fractured lead, and the extraction procedure was continued until the lead was removed. If the distal fragments were unable to be taken out, the procedure was deemed as either a partial radiographic success or having a lack of radiographic success; thus, procedural success was dependent on lead remnant length and infection presence [13][14][15][16]19,26]. This was our working hypothesis that needed to be verified.…”

“…Furthermore, little attention has been paid to the predictive role of incomplete lead extraction [20][21][22]. Surprisingly, there are many case reports describing lead fragments that embolize to the pulmonary arteries and the methods of their retrieval [23][24][25][26]. If possible, fragments of the broken lead should be removed [1][2][3]20,21] because they can be a source of persistent or recurrent infection after implantation of a new device [20,21].…”