Defibrillator leads using extraction sheaths

Al-Khadra AS, Wilkoff Bl, Byrd CL, et al. Extraction of nonthoracotomy defibrillator leads using the Spectranetics LASER sheath the US experience. (Abstract) PACE 1998 21 889. 

From January 1994 through April 1996, extraction of 3,540 leads from 2,338 patients (mean age 64 years, range 5-96) was attempted at 226 centers. Indications for removal were infection (27%), nonfunctional or incompatible leads (25%), Accufix or Encore leads (46%), or other causes (2%). The leads were implanted for a mean of 47 41 months (maximum 26 years) 53% were atrial leads, 46% ventricular leads, and 1% superior vena cava (SVC) defibrillating coils. The conventional technique for mechanical dilatation with Cook extraction-kit tools (Cook Vascular Inc., Leechburg, PA, USA) was used. Extraction was attempted via the implant vein using locking stylets and dilator sheaths and/or transfemorally... 

Defibrillator lead extraction is much more challenging when compared to pacemaker leads. This is because defibrillator leads are larger in diameter and have coils that can result in exuberant encapsulating fibrous scar attachment to endovascular structures. The defibrillator coils tend to promote dense fibrosis and fibrous bands that can attach to venous and myocardial structures. The extraction of such leads call for the use of larger extraction sheaths and... 

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