Retained Wire Lead Extraction Techniques in Patients With Venous Occlusion

Area of Science:

• Cardiology
• Interventional Cardiology
• Medical Device Technology

Background:

• Venous occlusion from indwelling cardiovascular implantable electronic device (CIED) leads hinders lead revision or system upgrades.
• Traditional methods for venous access restoration carry increased risks and complexity.
• Retained wire techniques offer a practical alternative, but require further data.

Purpose of the Study:

• To assess the feasibility, safety, and outcomes of four retained wire techniques combined with venoplasty.
• To re-establish venous access in patients with complete venous occlusion undergoing CIED procedures.

Main Methods:

• Retrospective analysis of patients undergoing transvenous lead extraction (TLE) for CIED revision or upgrade with complete venous occlusion.
• Utilized retained wire techniques: wire-under-insulation (above/below), wire-in-lumen, and wire-through-coronary sinus lead.
• Venoplasty was performed in conjunction with retained wire placement.

Main Results:

• Successful venous access re-establishment in 98% (49/50) of patients who underwent a retained wire strategy.
• The wire-in-lumen technique achieved a 97% success rate (35/36).
• One case of pericardial effusion occurred, managed with pericardiocentesis.

Conclusions:

• Retained wire techniques provide a safe and effective solution for venous occlusion during CIED procedures.
• The wire-in-lumen technique is highly successful and broadly applicable.
• These methods are particularly beneficial for mobile leads with modest dwell times.