1
|
Alves P, Silva J, Ribeiro J, Moreira S. Deep Vein Thrombosis in the Humeral Vein After Implantable Cardioverter-Defibrillator Implantation: A Family Physician's Perspective. Cureus 2023; 15:e50827. [PMID: 38249257 PMCID: PMC10797848 DOI: 10.7759/cureus.50827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2023] [Indexed: 01/23/2024] Open
Abstract
Upper extremity deep vein thrombosis (DVT) is an uncommon, under-reported, and difficult-to-diagnose condition. Although the strong provoking risk factors of venous thromboembolism are well described in the literature, the majority of cases are provoked by weak risk factors or are even considered unprovoked. In this case report, we describe a rare case of a brachial DVT in a woman in her 40s following implantable cardioverter-defibrillator (ICD) implantation. In her first evaluation, slight left arm edema and brachialgia were noted, and physiotherapy was prescribed. One month later, the patient was reevaluated because her complaints did not resolve, and an upper extremity venous ultrasound was done to exclude complications due to ICD implantation. The ultrasound identified an old DVT, which had been completely recanalized. The patient was then referred to a vascular surgery specialty consultation, which confirmed the diagnosis, and an anticoagulant was prescribed for three months. The symptoms resolved, and the patient did not report any more pain.
Collapse
Affiliation(s)
- Pedro Alves
- Family Medicine, USF (Unidade de Saude Familiar) Tâmega, Administração Regional de Saúde do Norte, Porto, PRT
| | - João Silva
- Family Medicine, USF (Unidade de Saude Familiar) Tâmega, Administração Regional de Saúde do Norte, Porto, PRT
| | - João Ribeiro
- Family Medicine, USF (Unidade de Saude Familiar) Alpendorada, Administração Regional de Saúde do Norte, Porto, PRT
| | - Sónia Moreira
- Family Medicine, USF (Unidade de Saude Familiar) Tâmega, Administração Regional de Saúde do Norte, Porto, PRT
| |
Collapse
|
2
|
Reinhardt A, Jansen H, Althoff T, Estner H, Iden L, Busch S, Rillig A, Johnson V, Sommer P, Tilz RR, Steven D, Duncker D. [Lead extraction in cardiac implantable electronic devices]. Herzschrittmacherther Elektrophysiol 2023; 34:339-350. [PMID: 37917360 DOI: 10.1007/s00399-023-00963-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 09/20/2023] [Indexed: 11/04/2023]
Abstract
Lead extraction due to infection or lead dysfunction has become more important in recent years. Patients with high risk of severe and life-threatening complications should only undergo surgery in experienced centers where appropriate personnel and equipment are available. In this review, different techniques and methods to safely and successfully perform transvenous lead extraction are summarized.
Collapse
Affiliation(s)
- Adrian Reinhardt
- Elektrophysiologie Bremen, Herzzentrum Bremen am Klinikum Links der Weser, Senator-Wessling-Straße 1, 28277, Bremen, Deutschland.
| | - Henning Jansen
- Elektrophysiologie Bremen, Herzzentrum Bremen am Klinikum Links der Weser, Senator-Wessling-Straße 1, 28277, Bremen, Deutschland
| | - Till Althoff
- Cardiovascular Institute (ICCV), Arrhythmia Section, CLINIC Barcelona University Hospital, Barcelona, Spanien
| | - Heidi Estner
- Klinik und Poliklinik für Innere Medizin I, Klinikum der Universität München, München, Deutschland
| | - Leon Iden
- Klinik für Kardiologie, Herz- und Gefäßzentrum Bad Segeberg, Bad Segeberg, Deutschland
| | - Sonia Busch
- Abteilung Elektrophysiologie. Herz-Zentrum Bodensee, Konstanz, Deutschland
| | - Andreas Rillig
- Universitäres Herzzentrum Hamburg, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - Victoria Johnson
- Klinik für Innere Medizin, Universitätsklinikum Gießen, Gießen, Deutschland
| | - Philipp Sommer
- Klinik für Elektrophysiologie/Rhythmologie, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Deutschland
| | - Roland R Tilz
- Klinik für Rhythmologie, Universitätsklinikum Schleswig-Holstein (UKSH), Campus Lübeck, Lübeck, Deutschland
| | - Daniel Steven
- Sektion Elektrophysiologie, Klinik III für Innere Medizin, Universitätsklinikum Köln, Köln, Deutschland
| | - David Duncker
- Hannover Herzrhythmus Centrum, Klinik für Kardiologie und Angiologie, Medizinische Hochschule Hannover, Hannover, Deutschland
| |
Collapse
|
3
|
Empfehlungen zur Sondenextraktion – Gemeinsame Empfehlungen der Deutschen Gesellschaft für Kardiologie (DGK) und der Deutschen Gesellschaft für Thorax‑, Herz- und Gefäßchirurgie (DGTHG). ZEITSCHRIFT FUR HERZ THORAX UND GEFASSCHIRURGIE 2022. [DOI: 10.1007/s00398-022-00512-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
4
|
Le KV, Okamura H, Homma T, Ohgo T, Noda T, Kusano K. Removal of a Hickman catheter using a laser sheath. J Arrhythm 2019; 35:158-160. [PMID: 30805062 PMCID: PMC6373650 DOI: 10.1002/joa3.12147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 11/05/2018] [Accepted: 11/19/2018] [Indexed: 11/25/2022] Open
Abstract
A 31-year-old female with 10 years indwelled Hickman catheter for idiopathic pulmonary hypertension presented infectious findings. We decided to remove it but simple traction did not work. Although it was an off labeled use, we could remove it using a laser sheath and snare technique without any complication.
Collapse
Affiliation(s)
- Kien Vo Le
- Department of Cardiovascular MedicineNational Cerebral and Cardiovascular CenterOsakaJapan
| | - Hideo Okamura
- Department of Cardiovascular MedicineNational Cerebral and Cardiovascular CenterOsakaJapan
| | - Takehiro Homma
- Department of Cardiovascular MedicineNational Cerebral and Cardiovascular CenterOsakaJapan
| | - Takeshi Ohgo
- Department of Cardiovascular MedicineNational Cerebral and Cardiovascular CenterOsakaJapan
| | - Takashi Noda
- Department of Cardiovascular MedicineNational Cerebral and Cardiovascular CenterOsakaJapan
| | - Kengo Kusano
- Department of Cardiovascular MedicineNational Cerebral and Cardiovascular CenterOsakaJapan
| |
Collapse
|
5
|
Recurrent Bacteremia After Heart Transplantation Due to Abandoned Lead Fragment in an Anonymous Vein-A Case Report. Transplant Proc 2018; 50:4071-4074. [PMID: 30577318 DOI: 10.1016/j.transproceed.2018.03.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 03/01/2018] [Indexed: 11/21/2022]
Abstract
Heart transplantation (HTx) represents the "gold standard" in end-stage heart failure therapy. Due to their severe heart failure and for prevention of sudden cardiac death, the majority of patients presenting for HTx will have a history of an implanted cardioverter-defibrillator (ICD). Usually, within the scope of HTx, all cardiac-implanted electronic device components are removed. In rare cases these efforts fail and some material remains. The abandoned lead fragments can cause serious complications. The case presented herein involves a patient with recurrent bacteremia after successful HTx originating from an abandoned and infected lead fragment. In 2016, a 64-year-old man received a donor heart transplant due to end-stage heart failure. Unfortunately, during the procedure, not all components of an ICD implanted in 2007 could be removed. An initially event-free period was followed by recurrent fever attacks and staphylococcal bacteremia was diagnosed. After an extensive search, the source of the bacteremia was identified by positron emission tomography-computed tomography (PET-CT), and percutaneous extraction of the abandoned and infected ICD lead fragment was scheduled. The fragment was extracted using a minimally invasive approach via percutaneous femoral vein access. The patient was discharged 3 days later, with no further complications. This case highlights the need for conscientious and complete removal of foreign material in the HTx setting. Difficult-to-diagnose sources of infection could be reliably identified by PET-CT. When required, extraction of the foreign body should be done using a minimally invasive approach.
Collapse
|
6
|
|
7
|
Sonny A, Wakefield BJ, Sale S, Mick S, Wilkoff BL, Mehta AR. Transvenous Lead Extraction: A Clinical Commentary for Anesthesiologists. J Cardiothorac Vasc Anesth 2018; 32:1101-1111. [PMID: 29482939 DOI: 10.1053/j.jvca.2018.01.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Indexed: 11/11/2022]
Abstract
With increasing use of cardiovascular implantable electronic devices, the need for lead extractions has increased to an annual volume of more than 10,000 extractions worldwide. This article provides a focused clinical commentary on the perioperative management, identification, and treatment of life-threatening complications associated with lead extractions. In addition, a summary of indications, techniques, and lead extraction complications is provided. Although uncommon, lead extractions are associated with a consistent rate of major procedure-related complications and mortality. Major life-threatening complications include vascular laceration, cardiac avulsion, hemothorax, pericardial effusion, and cardiac arrest. Comprehensive preoperative risk assessment and adequate planning and preparedness are crucial to decreasing all procedure-related adverse events. The location of the procedure (electrophysiology suite v hybrid operating room) and the nature of cardiac surgical backup are determined after meticulous risk stratification. In addition to decisions on vascular access, invasive monitoring, and modality of rhythm support, transesophageal echocardiography plays a crucial role in early diagnosis, timely management, and potential prevention of these complications.
Collapse
Affiliation(s)
- Abraham Sonny
- Department of Cardiothoracic Anesthesiology, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH; Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, MA
| | - Brett J Wakefield
- Department of Cardiothoracic Anesthesiology, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH.
| | - Shiva Sale
- Department of Cardiothoracic Anesthesiology, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH
| | - Stephanie Mick
- Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH
| | - Bruce L Wilkoff
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH
| | - Anand R Mehta
- Department of Cardiothoracic Anesthesiology, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH
| |
Collapse
|
8
|
Bhatia M, Safavi-Naeini P, Razavi M, Collard CD, Tolpin DA, Anton JM. Anesthetic Management of Laser Lead Extraction for Cardiovascular Implantable Electronic Devices. Semin Cardiothorac Vasc Anesth 2017; 21:302-311. [DOI: 10.1177/1089253217728581] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Cardiovascular implantable electronic devices (CIEDs) play a significant role in the modern management of cardiovascular disease. CIEDs include implantable pacemakers (PMs), implantable cardioverter-defibrillators (ICDs), and cardiac resynchronization therapy (CRT) devices. These devices improve the quality of life of their recipients and help reduce the incidence of sudden cardiac death. Traditionally, CIEDs have been reliant on the use of transvenous endocardial leads to directly connect with the heart. Over time, these endovascular leads may become endothelialized rendering removal extremely difficult. As the indications for CIEDs expands and with the continuing evolution of these devices, the number of patients requiring explantation for device recall, malfunction, and infection continues to increase. In this manuscript, we review the most common CIEDs, the indications and process of lead removal/device explantation, potential complications associated with the procedure and the anesthetic management of these patients.
Collapse
Affiliation(s)
- Meena Bhatia
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | | | | | | | | |
Collapse
|
9
|
Percutaneous occlusion balloon as a bridge to surgery in a swine model of superior vena cava perforation. Heart Rhythm 2016; 13:2215-2220. [PMID: 27343856 DOI: 10.1016/j.hrthm.2016.06.028] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Indexed: 11/22/2022]
Abstract
BACKGROUND Superior vena cava (SVC) perforation is a rare but potentially fatal complication of transvenous lead removal. OBJECTIVE The aim of this study was to evaluate the feasibility of hemodynamic stabilization using an occlusion balloon during SVC tear in a porcine model. METHODS A surgically induced SVC perforation was created in Yorkshire cross swine (n = 7). Three animals were used to develop and test surgical repair methods. Four animals were used to evaluate hemodynamic, behavioral, and neurological effects up to 5 days after SVC tear and repair. An occlusion balloon (Bridge Occlusion Balloon, Spectranetics Corporation, Colorado Springs, CO) was percutaneously delivered through the femoral vein to the location of the injury and inflated. Once hemodynamic control was achieved, the perforation was surgically repaired. RESULTS After SVC perforation and clamp release, the rate of blood loss was 7.0 ± 0.8 mL/s. Mean time from SVC tear to occlusion balloon deployment was 55 ± 12 seconds, during which mean arterial pressure decreased from 56 ± 2 to 25 ± 3 mm Hg and heart rate decreased from 76 ± 7 to 62 ± 7 beats/min. After the deployment of the occlusion balloon, the rate of blood loss decreased by 90%, to 0.7 ± 0.2 mL/s. The mean time of balloon occlusion of the SVC was 16 ± 4 minutes and hemodynamic measures returned to baseline levels during this time. Study animals experienced no major complications, demonstrated stable recovery, and exhibited normal neurological function at each postoperative assessment. CONCLUSION Endovascular temporary balloon occlusion may be a feasible option to reduce blood loss, maintain hemodynamic control, and provide a bridge to surgery after SVC injury.
Collapse
|
10
|
Williams KJ, O'Keefe S, Légaré JF. Creation of the sole regional laser lead extraction program serving Atlantic Canada: initial experience. Can J Surg 2016; 59:180-7. [PMID: 26999473 DOI: 10.1503/cjs.011115] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND An increasing need for laser lead extraction has grown in parallel with the increase of implantation of pacing and defibrillating devices. We reviewed the initial experience of a regional laser-assisted lead extraction program serving Atlantic Canada. METHODS We retrospectively reviewed the cases of all consecutive patients who underwent laser lead extraction at the Maritime Heart Centre in Halifax, NS, between 2006 and 2015. We conducted univariate and Kaplan-Meier survivorship analyses. RESULTS During the 9-year study period, 108 consecutive patients underwent laser lead extractions (218 leads extracted). The most common indication for extraction was infection (84.3%). Most patients were older than 60 years (73.1%) and had leads chronically implanted; the explanted leads were an average of 7.5 ± 6.8 years old. Procedural and clinical success (resolution of preoperative symptoms) rates and mortality were 96.8%, 97.2%, and 0.9%, respectively. Sternotomy procedures were performed in 3 instances: once for vascular repair due to perforation and twice to ensure that all infected lead material was removed. No minor complications required surgical intervention. Survival after discharge was 98.4% at 30 days and 94% at 12 months. CONCLUSION Atlantic Canada's sole surgical extraction centre achieved high extraction success with a low complication rate. Lead extraction in an operative setting provides for immediate surgical intervention and is essential for the survival of patients with complicated cases. Surgeons must weigh the risks versus benefits in patients older than 60 years who have chronically implanted leads (> 1 yr) and infection.
Collapse
Affiliation(s)
- Kenneth J Williams
- All authors are from the Department of Surgery, Division of Cardiac Surgery, Dalhousie University, Halifax, NS
| | - Scott O'Keefe
- All authors are from the Department of Surgery, Division of Cardiac Surgery, Dalhousie University, Halifax, NS
| | - Jean-Francois Légaré
- All authors are from the Department of Surgery, Division of Cardiac Surgery, Dalhousie University, Halifax, NS
| |
Collapse
|
11
|
Abstract
BACKGROUND Percutaneous lead extraction represents one of the most difficult and challenging interventions in the therapy with cardiac implantable electronic devices (CIEDs). Despite the progress in outcome and safety of these procedures in the last decade, the first published results of the ELECTRa registry point out that the risk of life-threatening complications should not be underestimated. Therefore, pre-operative screening for indications, present infections, pacemaker dependency, age and type of implanted leads, previous cardiac surgery and presence of anatomic variations are prerequisite to assess the individual operation risk. RESULTS Apart from the decision for any particular operative approach, the risk-adjusted settings should be selected in order to enable intraoperative escalation of extraction methods, if needed. A good theoretical knowledge of potential perioperative problems and complications as well as the intraoperative use of TEE enables early detection and management of complications. Furthermore, preoperative arrangements with other professionals and a team approach in emergency management enable fast and structured action when needed, thus, reducing mortality in case of life-threatening complications.
Collapse
Affiliation(s)
- Heiko Burger
- Abteilung für Herzchirurgie, Kerckhoff-Klinik GmbH, Benekestraße 2-8, 61231, Bad Nauheim, Deutschland.
| |
Collapse
|
12
|
Smith I, Rapchuk I, MacDonald C, Thomson B, Pearse B. Management of Exsanguination During Laser Lead Extraction. J Cardiothorac Vasc Anesth 2014; 28:1575-9. [DOI: 10.1053/j.jvca.2013.05.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2013] [Indexed: 11/11/2022]
|
13
|
Seow SC, Lim TW, Singh D, Yeo WT, Kojodjojo P. Permanent pacing in patients without upper limb venous access: a review of current techniques. HEART ASIA 2014; 6:163-6. [PMID: 27326197 DOI: 10.1136/heartasia-2014-010546] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/14/2014] [Indexed: 11/04/2022]
Abstract
Permanent transvenous cardiac pacing is usually accomplished through the upper limb veins. When these are occluded, several other vascular access options exist which include the internal jugular, external jugular, femoral and iliac veins as well as more proximal access of the subclavian veins. Anterograde and retrograde techniques to restore subclavian venous patency has been described. A review of these approaches is undertaken, with a discussion of their pros and cons. Familiarity with these techniques will enable the implanter to perform transvenous pacing when faced with limited vascular access.
Collapse
Affiliation(s)
- Swee-Chong Seow
- Cardiology Department , National University Heart Centre , Singapore , Singapore
| | - Toon-Wei Lim
- Cardiology Department , National University Heart Centre , Singapore , Singapore
| | - Devinder Singh
- Cardiology Department , National University Heart Centre , Singapore , Singapore
| | - Wee-Tiong Yeo
- Cardiology Department , National University Heart Centre , Singapore , Singapore
| | - Pipin Kojodjojo
- Cardiology Department , National University Heart Centre , Singapore , Singapore
| |
Collapse
|
14
|
GOYAL SANDEEPK, ELLIS CHRISTOPHERR, BALL STEPHENK, AHMAD RASHID, HOFF STEVENJ, WHALEN SPATRICK, ROTTMAN JEFFREY. High-Risk Lead Removal by Planned Sequential Transvenous Laser Extraction and Minimally Invasive Right Thoracotomy. J Cardiovasc Electrophysiol 2014; 25:617-21. [DOI: 10.1111/jce.12368] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2013] [Revised: 12/10/2013] [Accepted: 12/26/2013] [Indexed: 11/27/2022]
Affiliation(s)
- SANDEEP K. GOYAL
- Vanderbilt Heart and Vascular Institute; Vanderbilt University Medical Center; Nashville Tennessee USA
| | - CHRISTOPHER R. ELLIS
- Vanderbilt Heart and Vascular Institute; Vanderbilt University Medical Center; Nashville Tennessee USA
| | - STEPHEN K. BALL
- Vanderbilt Heart and Vascular Institute; Vanderbilt University Medical Center; Nashville Tennessee USA
| | - RASHID AHMAD
- Vanderbilt Heart and Vascular Institute; Vanderbilt University Medical Center; Nashville Tennessee USA
| | - STEVEN J. HOFF
- Vanderbilt Heart and Vascular Institute; Vanderbilt University Medical Center; Nashville Tennessee USA
| | - S. PATRICK WHALEN
- Vanderbilt Heart and Vascular Institute; Vanderbilt University Medical Center; Nashville Tennessee USA
| | - JEFFREY ROTTMAN
- Department of Veteran Affairs; Tennessee Valley Healthcare System; Nashville Tennessee USA
| |
Collapse
|