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Varicose Veins II: Diagnostic Studies and Interprofessional Care01:26

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Varicose veins, or varicosities, develop when the valves in the veins, which control blood flow, weaken or damage. It causes blood to pool and the veins to enlarge. Understanding the clinical manifestations, diagnostic approaches, and management options for varicose veins is crucial for effective treatment and relief.Clinical manifestationsClinical manifestations of varicose veins include a heavy, achy feeling or pain after prolonged standing or sitting. This discomfort can often be relieved by...
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Classification and Surgical Repair of Injuries Sustained During Transvenous Lead Extraction.

Jamil Bashir1, Lynn M Fedoruk2, John Ofiesh2

  • 1From the St Paul's Hospital, Department of Cardiovascular Surgery, University of British Columbia, Vancouver, Canada (J.B., S.S.K.); Royal Jubilee Hospital, Department of Cardiovascular Surgery, University of Victoria, BC, Canada (L.M.F., J.O.); and Vancouver Coastal Health, Department of Cardiovascular Surgery, University of British Columbia, Vancouver, Canada (G.F.O.T.). jmlbashir@gmail.com.

Circulation. Arrhythmia and Electrophysiology
|September 15, 2016
PubMed
Summary
This summary is machine-generated.

Cardiac and venous injuries during laser lead extraction are rare but serious. Prompt surgical intervention and cardiopulmonary bypass significantly improve survival rates for these complex cases.

Keywords:
cardiac surgerycardiac tamponadecardiopulmonary bypasslaserlead extractionpacemaker

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Area of Science:

  • Cardiovascular Surgery
  • Electrophysiology
  • Medical Device Complications

Background:

  • Injuries to cardiac and venous structures during pacemaker and defibrillator lead extraction are poorly understood complications.
  • The true incidence of these serious injuries is unknown and likely underestimated.
  • No systematic reviews have comprehensively examined these injuries or their management.

Purpose of the Study:

  • To investigate the incidence, presentation, and outcomes of cardiac and venous injuries during excimer laser lead extraction.
  • To analyze factors influencing injury severity and the effectiveness of management strategies.

Main Methods:

  • A mandatory administrative database was queried for all excimer laser lead extractions in British Columbia over 19 years.
  • Injuries were classified by presentation, nature, repair type, and need for cardiopulmonary bypass.
  • Outcomes, including 30-day survival, were analyzed in relation to injury characteristics and interventions.

Main Results:

  • Out of 1082 excimer laser lead extractions, 33 (3.0%) resulted in cardiac or venous injury.
  • Most injuries occurred in women, with a median oldest lead age of 10.8 years.
  • Circulatory collapse (Type 1) occurred in 36.4% and progressive hypotension (Type 2) in 60.6% of injured patients. Moderate to large injuries required cardiopulmonary bypass in 13 patients.

Conclusions:

  • Immediate availability of cardiovascular surgeons, perfusionists, and cardiopulmonary bypass is crucial for lifesaving repair of laser lead extraction injuries.
  • Injury size and complexity correlate with presentation, blood loss, and the need for cardiopulmonary bypass.
  • Aggressive salvage measures, including cardiopulmonary bypass, led to an 87.9% 30-day survival rate despite severe injuries.