5-YEARS EXPERIENCE WITH INTRAVASCULAR LEAD EXTRACTION

From December 1988 to April 1994, the extraction of 2,195 intravascula r pacing leads from 1,299 patients was attempted at 193 centers. Indic ations were: infection (54%, including 10% septicemia), pacemaker reop eration with removal of nonfunctional or incompatible leads (40%), and other causes (6%). Extraction was attempted via the implant vein usin g locking stylets and dilator sheaths, via the femoral vein using snar es, retrieval baskets, and sheaths, or via both approaches. Leads had been implanted for 0.2 months to 24 years (mean 56 months). At the con clusion of the intravascular procedure, 86.8% of the leads were comple tely removed, 7.5% were partially removed, and 5.7% were not removed. For physicians performing their first case, 12% of leads were not remo ved; for physicians who had performed more than 10 cases, only 2% of l eads were not removed. Of the 189 leads where extraction attempts had previously failed, 75.1% were completely removed, 14.8% were partially removed, and 10.1% were not removed. Scar tissue increased in severit y with implant duration, was a complicating factor, and was the main c ause of failure to remove leads. Use of the femoral approach increased with implant duration (5% of leads implanted 12 months or less, 11% o f leads 13 months to 3 years, 20% of leads 4-7 years, and 31% of leads 8-24 years), primarily because of increasingly abundant scarring and prior lead damage. Fatal and near fatal complications occurred in 2.5% , including 8(0.6%) deaths (3 hemopericardium/tamponade, 2 hemothorax, 3 pulmonary embolus, I stroke). With experienced operators, appropria te precautions, and appropriate patient selection, modern techniques a llow the successful extraction of up to nearly 98% of intravascular le ads with a relatively low incidence of complications.