A new extraction technique in lead transvenous removal : The Internal Transjugular Approach.

The technological improvement in the field of transvenous lead extraction is a needed consequence to resolve the increase of the indications to this procedure. In case of malfunction or infection the solution may be the replacement of device, the repositioning or addiction of a new lead, finally the lead extraction before a new implant. The last one rapresent the best treatment, because it can completely resolve the trouble. Transvenous lead extraction is on the other hand a complex procedure, actually effective, but potentially burdened by severe complications and strongly dependent from the staff experience. The Internal Transjugular Approach could represent, according on our experience, an useful modification to the standardized mechanical technique, able to improve the effectiveness of transvenous lead extraction expecially in case of difficult exposed or free-floating leads, increasing success rate and safety. Between October 2005 and July 2007, we evaluated 112 consecutive patients (81 males, mean age 66.2 years) admitted at our E.P Laboratory for submission to transvenous lead extraction procedures (201 leads considered for removal, mean implant time 66 months). According to the global experience, our results confirm that transvenous lead extraction is actually a procedure effective and safe, able to resolve the device-related complications in patients with indications as codified in the current Guidelines. We observe a further significant increase from the yet elevated 93.9% success rate for the standard mechanical dilatation, to the more elevated 97.1% success rate considering the possibility of a cross-over to Internal Transjugular Approach in case of failure, without addictioned complications. In our experience the possibility to adapt the technique to the specific situation, in particular with the use of Internal Transjugular Approach, may determine some advantages, improve the succes rate of the difficult procedures and reduce the complications risk.