A relevant Byrd dilator sheath damage during transvenous lead extraction – the rare phenomenon with potentially serious consequences

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

“…The sheath can be easily broken into two pieces if pulled or moved forward. BDF (not a complication unless a serious clinical event that may be life-threatening ensues) always requires special and careful sheath manoeuvres (tube removal or shift into the straight segment of the vein), also pulling the lead blocked by the broken sheath fragment, without countertraction, which may cause major procedural complications [21,22] (Figure 1). A-C).…”

“…Each successive rotation of the kinked polypropylene catheter rolls it up and tightens on the lead (E-H), making it more and more difficult to remove (D). Good quality fluoroscopy and careful observation of the entire working catheter can prevent secondary major problems [22].…”

“…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].…”

Stripping technique to remove stuck catheter: An alternative to Vollmar ring

“…The limit is the caliber as it is not available greater than 13 Fr, but I completely agree with Dr Hong 2 that the small calibre catheters might be more predisposed to the formation of adhesion when used for long period and the possibility that the Byrd dilator sheath get damaged in case of hard adhesions. 5…”