Extraction and Reimplantation of Defibrillation Leads Through a Thrombotic Subclavian Vein

Abstract

Venous thrombosis is one of the most frequently encountered obstacles when reintervening on endocardial leads. We report on two patients with a ventricular defibrillator requiring lead replacement in whom a subclavian vein thrombosis was documented prior to the intervention. We recanalized the vein and replaced the lead through the same path to preserve the venous access.

Lead Extraction Is Preferred for Lead Revisions and System Upgrades: When Less Is More

“…24,25,31 Similar outcomes have been reported with TLE for lead revision or device system upgrade. 40 -43 The safety and efficacy of telescoping sheaths for lead extraction in the setting of subclavian vein thrombosis were first reported by Le Franc et al 43 They described 2 patients with defibrillator systems and thrombosis of the implant vein who required the implantation of new pacing and defibrillator electrodes. Recanalization of the implant vein was achieved without complication through TLE with the use of locking stylets and telescoping sheaths.…”

Malfunction of endocardial defibrillator leads and lead extraction: where do they meet?

“…However, in case of lead related occlusion of the subclavian or brachiocephalic vein, lead extraction of a malfunctioning lead can provide ipsilateral venous access [33,34] . In two of our patients with obstructed venous access, laser sheath extraction allowed exchange of the malfunctioning lead for new leads through the same entry site.…”