Large laser sheaths for pacing and defibrillator lead removal

Reiser, Christopher; Taylor, Kevin; Lippincott, Rebecca A.

doi:10.1002/(sici)1096-9101(1998)22:1<42::aid-lsm10>3.0.co;2-a

Cited by 26 publications

(10 citation statements)

References 9 publications

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“…Because 308-nm wavelength penetrates only 50 to 100 μm through vascular tissue, precise tissue ablation is achieved immediately adjacent to the laser tip, with minimal risk of collateral tissue damage. 26 Although use of an excimer laser sheath to retrieve embedded IVC filters is a novel application not currently approved by the FDA, the method of endovascular laser tissue ablation to free adherent venous pacemaker leads is a well-established technique. Earlier studies such as the Pacemaker Lead Extraction with the Excimer Sheath (PLEXES) trial showed that a laser sheath method significantly improved the efficiency of transvenous lead extraction, particularly through ablation of dense fibrous tissue, reducing the magnitude of necessary force.…”

Section: Discussionmentioning

confidence: 99%

Excimer Laser–Assisted Removal of Embedded Inferior Vena Cava Filters

Kuo

Odegaard

Rosenberg

et al. 2013

Circ: Cardiovascular Interventions

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Background-Although chronically implanted inferior vena cava filters may result in filter-related morbidity, there is currently no routine option for removing such filters when they become firmly embedded along the vena cava endothelium. Methods and Results-During a 3-year period, 100 consecutive patients were prospectively enrolled in a single-center study. There were 42 men and 58 women (mean age, 46 years; limits, 18-76 years). Retrieval indications included filterrelated acute inferior vena cava thrombosis, chronic inferior vena cava occlusion, and pain from retroperitoneal or bowel penetration. Filter retrieval was also performed to prevent risks from prolonged implantation and to potentially eliminate the need for lifelong anticoagulation. After standard methods failed, photothermal tissue ablation was attempted with a laser sheath powered by a 308-nm xenon chloride excimer laser. Applied forces were recorded with a digital tension meter before and during laser activation. Laser-assisted retrieval was successful in 98.0% (95% confidence interval [CI], 93.0%-99.8%) with mean implantation of 855 days (limits, 37-6663 days; >18 years). The following filter types were encountered in this study: Günther-Tulip (n=34), Celect (n=12), Option (n=17), Optease (n=20, 1 failure), TrapEase (n=6, 1 failure), Simon-Nitinol (n=1), 12F Stainless Steel Greenfield (n=4), and Titanium Greenfield (n=6). The average force during failed standard retrievals was 7.2 versus 4.6 pounds during laser-assisted retrievals (P<0.0001). The major complication rate was 3.0% (95% CI, 0.6%-8.5%), the minor complication rate was 7.0% (95% CI, 0.3%-13.9%), and there were 4 adverse events (2 coagulopathic hemorrhages, 1 renal infarction, and 1 cholecystitis; 4.0%; 95% CI, 1.1%-9.9%) at mean follow-up of 500 days (limits, 84-1079 days). Scar tissue ablation was histologically confirmed in 96.0% (95% CI, 89.9%-98.9%). Successful retrieval allowed cessation of anticoagulation in 30 of 30 (100%) patients and alleviated morbidity in 23 of 24 patients (96%). Conclusions-Excimer laser-assisted removal is effective in removing embedded inferior vena cava filters refractory to standard retrieval and high force. This method can be safely used to prevent and alleviate filter-related morbidity. Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT01158482.

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Section: Discussionmentioning

confidence: 99%

Excimer Laser–Assisted Removal of Embedded Inferior Vena Cava Filters

Kuo

Odegaard

Rosenberg

et al. 2013

Circ: Cardiovascular Interventions

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“…The type of sheath system being used may play a role in efficacy as well. The PLEXES trial randomized patients to excimer laser or nonpowered sheaths 46–51 . The study concluded that the laser was significantly more effective (94% vs 64%, P = 0.001) and reduced the extraction time (10.1 ± 11.5 minutes vs 12.9 ± 19.2 minutes, P <.04).…”

Section: Efficacy and Safetymentioning

confidence: 99%

Extraction of Transvenous Pacing and ICD Leads

Smith

Love²

2008

Pacing Clinical Electrophis

155

112

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The emergence of pacing and implantable cardioverter-defibrillator (ICD) systems, along with expanding indications of these devices (e.g., cardiac resynchronization therapy and sudden cardiac death prevention), increasing infection rates, and device recalls have created the need for removing and upgrading these systems due to various reasons. Removing the pulse generator of a system is generally uncomplicated. Chronically implanted transvenous leads, however, adhere to the venous endothelium and endocardial tissues over time due to fibrosis. Removal of such leads can be a significantly complex procedure requiring tools and techniques that free the lead at fibrotic binding sites. In this article, the state-of-the-art tools and techniques that provide a systematic approach to consistently and safely extract these devices will be reviewed.

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“…Because the penetration depth of 308 nm light in vascular tissue is approximately 100 lm, the laser light is completely absorbed by the tissue immediately in front of the tip. This produces a controlled and precise removal of only the tissue directly in contact with the laser tip [15]. Although the laser-assisted technique for filter retrieval is a new application in the human IVC, the method of endovascular laser sheath ablation to free adherent cardiac pacemaker leads is a well-established technique [16].…”

Section: Discussionmentioning

confidence: 99%