Mechanical Dilator Sheath Markedly Damaged by Fibrosis

Abstract

Transvenous lead extraction (TLE) procedures, despite the high success rate could esistate in life-threatening consequences. The operator experience is crucial for the procedural outcome and every procedure can hide unexpected difficulties as the one encountered in the case presented. During a double coil lead defibrillator extraction, with an apparently preserved maneuverability of the mechanical dilator, a further control of the sheath revealed its complete fracture with the risk of losing part of it inside the vein.Keywords: Transvenous lead extraction; Mechanical dialtor sheath; Fibrosis IntroductionThe need of transvenous lead extraction (TLE) procedures are steadily increasing nowadays with an estimated 10 000-15 000 pacemaker and implantable cardioverter-defibrillator (ICD) leads extracted annually worldwide. This increased number of TLE procedures is surely related to the extensive use of polypropylene dilator sheath was then used and the procedure was successful accomplished. DiscussionThe case presented suggests that during TLE procedures performed with mechanical dilator sheath in place of strong fibrosis, a continuous dilator check integrity, is desiderable even if a rotational maneuverability seems preserved to avoid dilator rupture. Mechanical dilator sheath integrity has to be checked frequently during extraction procedures. Fluoroscopic control cannot exclude sheath ruptures. In case of hard fibrosis alternative extraction methods have to be considered. Conflicts of Interest & DisclosureAntonio Curnis is a consultant of Boston Scientific, Medtronic, Biotronik, Abbott, LivaNova, Spectranetics. Luca Bontempi is a consultant of Boston Scientific, Medtronic, Biotronik, Abbott, LivaNova.