Successful pacemaker lead extraction involving an ossified thrombus: A case report

Area of Science:

• Cardiology
• Medical Devices
• Vascular Surgery

Background:

• Pacemaker lead extraction is often necessary due to infection or lead malfunction.
• Long-standing intravascular leads are prone to complications, including venous thrombosis.
• Ossified thrombus presents a significant challenge for lead extraction procedures.

Purpose of the Study:

• To describe a challenging pacemaker lead extraction due to ossified thrombus.
• To highlight the difficulties encountered with standard extraction techniques.
• To present a successful extraction using modified approaches.

Main Methods:

• A 41-year-old patient with an 18-year-old pacemaker presented with device infection.
• Initial attempts at lead extraction using a laser sheath were unsuccessful due to binding in the innominate vein.
• A rotating mechanical sheath was employed but halted due to calcified tissue.
• Calcified tissue was removed, and subsequent extraction was successful using the laser sheath.

Main Results:

• The presence of ossified thrombus significantly impeded lead extraction.
• Initial use of laser and mechanical sheaths failed to overcome the binding.
• Successful lead extraction was achieved after removal of calcified thrombus fragments.
• Pathological examination confirmed ossified thrombus as the cause of difficulty.

Conclusions:

• Venous thromboses associated with implanted leads can ossify over time.
• Ossified thrombus poses a substantial obstacle to the extraction of long-dwelling intravascular leads.
• Modified extraction techniques may be required to manage complex cases of lead-associated ossified thrombus.