Techniques for transvenous leads extraction

The number of implanted cardiac pacing and defibrillating devices is currently increasing, leading to an increasing number of device-related complications, due to either malfunction or infection. Removal of the whole system, including the leads, was proven to be the most effective therapy. At present the importance of transvenous lead extraction is consequently increased. In order to remove pacing and implantable cardioverter defibrillators (ICD) leads, they have to be made free from any binding site from the entry in the vein to the tip. Different techniques, including mechanical dilation, powered dilation and intravascular approaches have been developed over the last years and are currently available. Results reported in the literature show a significant success rate (ranging between 90% and 98% of the leads) and a reduced incidence of serious complications (1% to 3% in different series) in selected centres. The extraction procedures are complex and life-threatening complications may always occur, suggesting the need of trained and experienced operators as well as the availability of a surgical standby. At present indications to removal are restricted to infection or to damage of the leads inducing serious risk for the patients; the availability of a more effective and safe technique will probably spread indications to most of abandoned leads.