Transvenous recovery of an intracardiac fractured port-A catheter fragment
2015; Elsevier BV; Volume: 185; Linguagem: Inglês
10.1016/j.ijcard.2015.03.087
ISSN1874-1754
AutoresGiuseppe Mario Calvagna, Salvatore Patanè, Placido Romeo, Sonja Condorelli, Ludovico Vasquez,
Tópico(s)Cardiac electrophysiology and arrhythmias
ResumoThe optimal management of implanted devices has become a serious worldwide challenge and many techniques for addressing device complications have been developed including endovascular retrieval of lost or misplaced fractured foreign objects [ [1] Calvagna G.M. Romeo P. Ceresa F. Valsecchi S. Transvenous retrieval of foreign objects lost during cardiac device implantation or revision: a 10-year experience. Pacing Clin. Electrophysiol. Jul 2013; 36: 892-897 Crossref PubMed Scopus (32) Google Scholar ]. The use of implantable cardiac devices has increased in the last 30 years [ 1 Calvagna G.M. Romeo P. Ceresa F. Valsecchi S. Transvenous retrieval of foreign objects lost during cardiac device implantation or revision: a 10-year experience. Pacing Clin. Electrophysiol. Jul 2013; 36: 892-897 Crossref PubMed Scopus (32) Google Scholar , 2 Calvagna G.M. Patanè S. Severe staphylococcal sepsis in patient with permanent pacemaker. Int. J. Cardiol. 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Complicanze non infettive o malfunzionamenti in pazienti portatori di PM e/o ICD: importanza della rimozione transvenosa. G. Ital. Aritmol. Cardiostim. 2009; 12: 69-78 Google Scholar , 41 Calvagna G.M. Patanè S. Romeo P. Ceresa F. Sansone F. Patanè F. Embolization and retrieval of an anchoring sleeve during transvenous lead extraction. Int. J. Cardiol. May 15 2014; 173: e42-e44 Abstract Full Text Full Text PDF PubMed Scopus (27) Google Scholar , 42 Calvagna G.M. Foti R. Lisi M. Evola R. Rimozione transvenosa manuale di elettrocateteri da Pacemaker e\o ICD malfunzionanti o infetti mediante tecnica transvenosa manuale: Esperienza di unico centro regionale dedicato (anni 2002–2007). G. It. Aritmol. Cadiostim. 2007; 4: 30-35 Google Scholar , 43 Calvagna G.M. Evola R. Scardace G. Valsecchi S. Single-operator experience with a mechanical approach for removal of pacing and implantable defibrillator leads. Europace. 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Howard P. Olson E. Perry J.D. Prendergast B.D. Spry M.J. Steeds R.P. Tayebjee M.H. Watkin R. Guidelines for the diagnosis, prevention and management of implantable cardiac electronic device infection. Report of a joint Working Party project on behalf of the British Society for Antimicrobial Chemotherapy (BSAC, host organization), British Heart Rhythm Society (BHRS), British Cardiovascular Society (BCS), British Heart Valve Society (BHVS) and British Society for Echocardiography (BSE). J. Antimicrob. Chemother. Feb 2015; 70: 325-359 Crossref PubMed Scopus (274) Google Scholar , 8 Scarano M. Pezzuoli F. Torrisi G. Calvagna G.M. Patanè S. Cardiovascular implantable electronic devices infective endocarditis. Int. J. Cardiol. May 15 2014; 173: e38-e39 Abstract Full Text Full Text PDF PubMed Scopus (35) Google Scholar , 28 Calvagna G.M. Recall, malfunzionamenti e infezioni in portatori di PM/ICD. Possono condizionare le scelte clinico-interventistiche e la qualità della vita?. GIAC. 2010; 13: 217-222 Google Scholar , 29 Scarano M. Pezzuoli F. Patanè S. Brucella infective endocarditis. Int. J. Cardiol. Apr 1 2014; 172: e509-e510 Abstract Full Text Full Text PDF PubMed Scopus (27) Google Scholar , 30 Patanè S. Is there a need for bacterial endocarditis prophylaxis in patients undergoing urological procedures?. J. Cardiovasc. Transl. Res. Apr 2014; 7: 369-371 Crossref PubMed Scopus (41) Google Scholar , 31 Patanè S. Is there a need for bacterial endocarditis prophylaxis in patients undergoing gastrointestinal endoscopy?. J. Cardiovasc. Transl. Res. Apr 2014; 7: 372-374 Crossref PubMed Scopus (39) Google Scholar , 32 Calvagna G.M. Progressivo malfunzionamento di elettrocatetere da stimolazione cardiaca permanente secondario a processo infettivo asintomatico. GIAC. 2012; 15: 51-54 Google Scholar , 33 Calvagna G.M. Curatolo S. La Greca S. Evola R. Sepsi Stafilococciche in pazienti portatori di PM e\o ICD: Dal trattamento antibiotico all'intervento di Rimozione Transvenosa Manuale. G. It. Aritmol. Cardiostim. Marzo 2010; 13 Google Scholar , 34 Patanè S. A dark side of the cardio-oncology: the bacterial endocarditis prophylaxis. Int. J. Cardiol. Jun 14 2012; 157: 448-449 Abstract Full Text Full Text PDF PubMed Scopus (41) Google Scholar , 35 Calvagna G.M. Mangano A. Evola R. Infezioni su estremita' distali degli elettrocateteri da stimolazione cardiaca permanente rimossi mediante tecnica transvenosa manuale: casistica dal 2002 al 2007 presso centro unico dedicato. G. Ital. Aritmol. Cardiostim. 2008; 4: 65-68 Google Scholar , 36 Calvagna G.M. Patanè S. Transvenous pacemaker lead extraction in infective endocarditis. Int. J. Cardiol. Sep 20 2014; 176: 511-513 Abstract Full Text Full Text PDF PubMed Scopus (27) Google Scholar ] and noninfectious complications [ 9 Ahmed S. Ungprasert P. Srivali N. Ratanapo S. Cheungpasitporn W. Chongnarungsin D. Lead perforation: an uncommon cause of chest pain in a patient with pacemaker. Int. J. Cardiol. Sep 1 2013; 167: e113-e114 Abstract Full Text Full Text PDF PubMed Scopus (21) Google Scholar , 21 La Rocca R. Materia V. Falliano M.F. Sciacca N. Marte F. Patanè S. Hyperkalaemic cardiac arrhythmia with pacemaker/implantable cardioverter-defibrillator action disturbance. Int. J. Cardiol. May 3 2012; 156: e49-e50 Abstract Full Text Full Text PDF PubMed Scopus (20) Google Scholar , 23 Calvagna G.M. Ceresa F. Patanè S. Subcutaneous implantable cardioverter-defibrillator in a young woman. Int. J. Cardiol. Aug 1 2014; 175: e30-e32 Abstract Full Text Full Text PDF PubMed Scopus (24) Google Scholar , 37 Imazio M. Hoit B.D. Post-cardiac injury syndromes. An emerging cause of pericardial diseases. Int. J. Cardiol. Sep 30 2013; 168: 648-652 Abstract Full Text Full Text PDF PubMed Scopus (166) Google Scholar , 38 Chikata A. Omi W. Saeki T. Nagai H. Sakagami S. Repeated pacemaker dysfunction in a patient with recurrent takotsubo cardiomyopathy precipitated by hyponatremia. Int. J. Cardiol. Jan 1 2014; 170: 443-444 Abstract Full Text Full Text PDF PubMed Scopus (26) Google Scholar , 39 Kawata H. Patel J. McGarry T. Joshi R. Krummen D. Feld G. Birgersdotter-Green U. Obese female patients have higher rates of lead dislodgement after ICD or CRT-D implantation. Int. J. Cardiol. Apr 1 2014; 172: e522-e524 Abstract Full Text Full Text PDF PubMed Scopus (27) Google Scholar , 40 Calvagna G.M. Evola R. Complicanze non infettive o malfunzionamenti in pazienti portatori di PM e/o ICD: importanza della rimozione transvenosa. G. Ital. Aritmol. Cardiostim. 2009; 12: 69-78 Google Scholar ] often necessitating removal [ 1 Calvagna G.M. Romeo P. Ceresa F. Valsecchi S. Transvenous retrieval of foreign objects lost during cardiac device implantation or revision: a 10-year experience. Pacing Clin. Electrophysiol. Jul 2013; 36: 892-897 Crossref PubMed Scopus (32) Google Scholar , 2 Calvagna G.M. Patanè S. Severe staphylococcal sepsis in patient with permanent pacemaker. Int. J. Cardiol. Apr 1 2014; 172: e498-e501 Abstract Full Text Full Text PDF PubMed Scopus (28) Google Scholar , 8 Scarano M. Pezzuoli F. Torrisi G. Calvagna G.M. Patanè S. Cardiovascular implantable electronic devices infective endocarditis. Int. J. Cardiol. May 15 2014; 173: e38-e39 Abstract Full Text Full Text PDF PubMed Scopus (35) Google Scholar , 40 Calvagna G.M. Evola R. Complicanze non infettive o malfunzionamenti in pazienti portatori di PM e/o ICD: importanza della rimozione transvenosa. G. Ital. Aritmol. Cardiostim. 2009; 12: 69-78 Google Scholar , 41 Calvagna G.M. Patanè S. Romeo P. Ceresa F. Sansone F. Patanè F. Embolization and retrieval of an anchoring sleeve during transvenous lead extraction. Int. J. Cardiol. May 15 2014; 173: e42-e44 Abstract Full Text Full Text PDF PubMed Scopus (27) Google Scholar , 42 Calvagna G.M. Foti R. Lisi M. Evola R. Rimozione transvenosa manuale di elettrocateteri da Pacemaker e\o ICD malfunzionanti o infetti mediante tecnica transvenosa manuale: Esperienza di unico centro regionale dedicato (anni 2002–2007). G. It. Aritmol. Cadiostim. 2007; 4: 30-35 Google Scholar , 43 Calvagna G.M. Evola R. Scardace G. Valsecchi S. Single-operator experience with a mechanical approach for removal of pacing and implantable defibrillator leads. Europace. Nov 2009; 11: 1505-1509 Crossref PubMed Scopus (43) Google Scholar , 44 Calvagna G.M. Evola R. Scardace G. Valsecchi S. Successful removal of a jugular implantable defibrillator lead with mechanical single-sheath technique. Pacing Clin. Electrophysiol. Sep 2012; 35: e258-e260 Crossref PubMed Scopus (21) Google Scholar , 45 Calvagna G.M. Evola R. Valsecchi S. 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Intravascular recovery of electrode fragments as a possible complication of transvenous removal intervention. Int. J. Cardiol. Dec 15 2014; 177 Abstract Full Text Full Text PDF Scopus (19) Google Scholar , 74 Patanè S. Is there a role for quinazoline-based α(1)-adrenoceptor antagonists in cardio-oncology?. Card. Drugs Ther. Dec 2014; 28: 587-588 Crossref PubMed Scopus (27) Google Scholar , 75 Calvagna G.M. Costanzo L. Di Pino A. Patanè S. Leads extraction in a young girl with dehiscence of a pacemaker implanted in the subpectoral region. Int. J. Cardiol. Oct 20 2014; 176: e135-e136 Abstract Full Text Full Text PDF PubMed Scopus (17) Google Scholar , 76 Romeo P. Calvagna G.M. Giunta M. Vitale F.V. Patanè S. Removal of an intracardiac lost port—a catheter utilizing a simple low-cost method. Int. J. Cardiol. Oct 20 2014; 176: 1309-1311 Abstract Full Text Full Text PDF PubMed Scopus (20) Google Scholar , 77 Patanè S. Regulator of G-protein signaling 2 (RGS2) in cardiology and oncology. 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Jan 20 2015; 179 Abstract Full Text Full Text PDF Scopus (10) Google Scholar ] also includes patients needing device revision and upgrade. In addition, improved patients' survival, a progressively younger implanted population and the increase in device and procedure complexity have raised the risk of system component structural failures [ 82 Schuchert A. Muto C. Maounis T. Frank R. Boulogne E. Polauck A. Padeletti L. MASCOT study groupLead complications, device infections, and clinical outcomes in the first year after implantation of cardiac resynchronization therapy-defibrillator and cardiac resynchronization therapy-pacemaker. Europace. Jan 2013; 15: 71-76 Crossref PubMed Scopus (58) Google Scholar , 83 Wilkoff B.L. et al. Transvenous lead extraction: Heart Rhythm Society expert consensus on facilities, training, indications and patient management. Heart Rhythm. 2009; 6: 1085 Abstract Full Text Full Text PDF PubMed Scopus (925) Google Scholar , 84 Calvagna G.M. Patanè S. Cardiac rehabilitation in pacing patient complications: an increasing scenario requiring a collaborative vision of a multi-disciplinary treatment team. Int. J. Cardiol. Oct 24 2014; 178C: 168-170 Abstract Full Text Full Text PDF Scopus (12) Google Scholar , 85 Calvagna G.M. Patanè S. Cardiac rehabilitation in pacing venous occlusions. Int. J. Cardiol. Jan 20 2015; 179: 248-251 Abstract Full Text Full Text PDF PubMed Scopus (14) Google Scholar , 86 Calvagna G.M. Patanè S. Pacing venous occlusion. Int. J. Cardiol. Nov 26 2014; 181C: 42-45 Abstract Full Text Full Text PDF PubMed Scopus (11) Google Scholar , 87 Calvagna G.M. Patanè S. Transvenous pacemaker lead extraction by femoral approach. Int. J. Cardiol. Nov 25 2014; 180C: 145-148 Abstract Full Text Full Text PDF Scopus (10) Google Scholar ]. For these reasons, the necessity of extraction has become increasingly higher and the development of specific techniques and tools to reduce morbidity and mortality associated with the removal of pacing devices has played an important role representing the cornerstone of modern clinical cardiac electrophysiology as well as efficacious implantation and management of cardiac devices. A mechanical technique (transvenous lead extraction) is an effective technique with few complications, but the collaborative vision of a multi-disciplinary treatment team [ 53 Calvagna G.M. Torrisi G. Giuffrida C. Patanè S. Pacemaker, implantable cardioverter defibrillator, CRT, CRT-D, psychological difficulties and quality of life. Int. J. Cardiol. Jun 15 2014; 174: 378-380 Abstract Full Text Full Text PDF PubMed Scopus (32) Google Scholar , 72 Ceresa F. Calvagna G.M. Patanè S. Di Maggio E.M. Romeo P. Patanè F. Cardiac perforation of the right ventricle: a rare complication of pacemaker implantation. The importance of a collaborative vision of a multi-disciplinary treatment team. Int. J. Cardiol. Dec 15 2014; 177: 621-624 Abstract Full Text Full Text PDF PubMed Scopus (14) Google Scholar ] is required for the patient's safety and complete rehabilitation [ 82 Schuchert A. Muto C. Maounis T. Frank R. Boulogne E. Polauck A. Padeletti L. MASCOT study groupLead complications, device infections, and clinical outcomes in the first year after implantation of cardiac resynchronization therapy-defibrillator and cardiac resynchronization therapy-pacemaker. Europace. Jan 2013; 15: 71-76 Crossref PubMed Scopus (58) Google Scholar , 83 Wilkoff B.L. et al. Transvenous lead extraction: Heart Rhythm Society expert consensus on facilities, training, indications and patient management. Heart Rhythm. 2009; 6: 1085 Abstract Full Text Full Text PDF PubMed Scopus (925) Google Scholar , 84 Calvagna G.M. Patanè S. Cardiac rehabilitation in pacing patient complications: an increasing scenario requiring a collaborative vision of a multi-disciplinary treatment team. Int. J. Cardiol. Oct 24 2014; 178C: 168-170 Abstract Full Text Full Text PDF Scopus (12) Google Scholar , 85 Calvagna G.M. Patanè S. Cardiac rehabilitation in pacing venous occlusions. Int. J. Cardiol. Jan 20 2015; 179: 248-251 Abstract Full Text Full Text PDF PubMed Scopus (14) Google Scholar , 86 Calvagna G.M. Patanè S. Pacing venous occlusion. Int. J. Cardiol. Nov 26 2014; 181C: 42-45 Abstract Full Text Full Text PDF PubMed Scopus (11) Google Scholar , 87 Calvagna G.M. Patanè S. Transvenous pacemaker lead extraction by femoral approach. Int. J. Cardiol. Nov 25 2014; 180C: 145-148 Abstract Full Text Full Text PDF Scopus (10) Google Scholar , 88 Calvagna G.M. Patanè S. A complete bicameral pacemaker pocket decubitus. Int. J. Cardiol. Dec 24 2014; 181C: 340-343 Abstract Full Text Full Text PDF PubMed Scopus (8) Google Scholar ]. The safety and effectiveness of transvenous lead extraction has also been demonstrated for difficult dialysis catheter [ [89] Calvagna G.M. Ceresa F. Morgante A. Patanè S. Transvenous extraction of a left subclavian dialysis catheter: a new challenge in cardiology. Int. J. Cardiol. Mar 10 2015; 185: 144-147 Abstract Full Text Full Text PDF PubMed Scopus (7) Google Scholar ] and port catheter removal [ [76] Romeo P. Calvagna G.M. Giunta M. Vitale F.V. Patanè S. Removal of an intracardiac lost port—a catheter utilizing a simple low-cost method. Int. J. Cardiol. Oct 20 2014; 176: 1309-1311 Abstract Full Text Full Text PDF PubMed Scopus (20) Google Scholar ]. The difficult extraction of dialysis catheters due to a hard fibrin sheath along their course and spontaneous fracture and migration of implanted port catheters are emerging common drawbacks [ 76 Romeo P. Calvagna G.M. Giunta M. Vitale F.V. Patanè S. Removal of an intracardiac lost port—a catheter utilizing a simple low-cost method. Int. J. Cardiol. Oct 20 2014; 176: 1309-1311 Abstract Full Text Full Text PDF PubMed Scopus (20) Google Scholar , 89 Calvagna G.M. Ceresa F. Morgante A. Patanè S. Transvenous extraction of a left subclavian dialysis catheter: a new challenge in cardiology. Int. J. Cardiol. Mar 10 2015; 185: 144-147 Abstract Full Text Full Text PDF PubMed Scopus (7) Google Scholar ] as well as the retrieval and removal of foreign intravascular bodies to prevent cardiovascular complications. We present the case of a 40-year-old Italian woman with a history of an implanted right subclavian port-A catheter in 2012 for colorectal adenocarcinoma chemotherapy. Chest X-ray examination revealed the presence of a spontaneous fracture and embolization and migration of a fixed fragment with a size of about 10 cm placed between the right atrium and right ventricle across the tricuspid valve (Fig. 1 panels A and B). We successfully performed the recovery of the fragment from the right femoral venous access through Seldinger's technique with a TIP Deflecting Wire Guide (Cook Vascolar) used for moving it and a recovery loop AndraSnare AS-25 (125 cm; 5 Fr; Andramed model) used for its capture (Fig. 2). Also this case focuses on the safety and effectiveness of transvenous lead extraction and it is illustrative of its use as a new challenge in cardiology. Fig. 2The fragment recovery performed successfully from the right femoral venous access through Seldinger's technique with a TIP Deflecting Wire Guide (Cook Vascolar) used for moving it and a recovery loop AndraSnare AS-25 (125 cm; 5 Fr; Andramed model) used for its capture. View Large Image Figure Viewer Download Hi-res image
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